Emory University School of Medicine, Atlanta, GA; Emory University Rollins School of Public Health, Atlanta, GA.
Department of Biostatistics and Bioinformatics, Winship Cancer Institute, Emory University, Atlanta, GA.
Clin Lung Cancer. 2017 Nov;18(6):706-718. doi: 10.1016/j.cllc.2017.04.009. Epub 2017 Apr 28.
Current evidence-based guideline-concordant care (GCC) for locally advanced non-small-cell lung cancer (NSCLC) patients with good performance status is concurrent chemoradiation. In this study we evaluated factors associated with lack of GCC and its effects on overall survival (OS).
Unresectable stage III NSCLC patients, diagnosed from 2005 to 2013 with a Charlson-Deyo score of 0, were identified from the National Cancer Database. Primary outcomes were receipt of GCC, defined as concurrent chemoradiation (thoracic radiotherapy, starting within 2 weeks of chemotherapy, to at least 60 Gy), and OS. Multivariable logistic regression modeling identified variables associated with non-GCC. Cox proportional hazard modeling was used to examine OS.
Twenty-three percent of patients (n = 10,476) received GCC. Uninsured patients were more likely to receive non-GCC (odds ratio [OR], 1.54; P < .001) compared with privately insured patients. Other groups with greater odds of receiving non-GCC included: patients treated in the western, southern, or northeastern United States (ORs, 1.39, 1.37, and 1.19, respectively; all Ps < .001) compared with the Midwest; adenocarcinoma histology (OR, 1.48; P < .001) compared with squamous cell carcinoma; and women (OR, 1.08; P = .002). Those who received non-GCC had higher death rates compared with those who received GCC (hazard ratio [HR], 1.42; P < .001). The uninsured (HR, 1.53; P < .001), patients treated in the western, southern, or northeastern United States (HRs, 1.56, 1.41, and 1.34, respectively; P < .001), adenocarcinomas (HR, 1.39; P < .001), and women (HR, 1.44; P < .001) also all had lower OS for non-GCC versus GCC.
Socioeconomic factors, including lack of insurance and geography, are associated with non-GCC. Patient- and disease-specific factors, including increasing adenocarcinoma histology and sex, are also associated with non-GCC. Non-GCC diminishes OS.
对于身体状况良好的局部晚期非小细胞肺癌（NSCLC）患者，目前循证指南一致推荐的治疗方法是同步放化疗。本研究评估了与缺乏指南一致的治疗（GCC）相关的因素及其对总生存期（OS）的影响。
从国家癌症数据库中确定了 2005 年至 2013 年期间Charlson-Deyo 评分为 0 的不可切除的 III 期 NSCLC 患者。主要结局是接受 GCC，定义为同步放化疗（胸部放疗，在化疗开始后 2 周内进行，至少 60Gy）和 OS。多变量逻辑回归模型确定了与非 GCC 相关的变量。Cox 比例风险模型用于检查 OS。
23%的患者（n=10476）接受了 GCC。与私人保险患者相比，未参保患者更有可能接受非 GCC（优势比 [OR]，1.54；P<0.001）。其他接受非 GCC 治疗可能性更大的组包括：在美国西部、南部或东北部接受治疗的患者（OR 分别为 1.39、1.37 和 1.19；所有 P<0.001），与中西部相比；腺癌组织学（OR，1.48；P<0.001）与鳞状细胞癌相比；以及女性（OR，1.08；P=0.002）。与接受 GCC 的患者相比，接受非 GCC 的患者死亡率更高（风险比 [HR]，1.42；P<0.001）。未参保患者（HR，1.53；P<0.001）、在美国西部、南部或东北部接受治疗的患者（HR 分别为 1.56、1.41 和 1.34；P<0.001）、腺癌（HR，1.39；P<0.001）和女性（HR，1.44；P<0.001）接受非 GCC 治疗的患者 OS 也较低。
社会经济因素，包括缺乏保险和地理位置，与非 GCC 相关。患者和疾病特异性因素，包括腺癌组织学和性别增加，也与非 GCC 相关。非 GCC 降低 OS。
