Verleye L, De Gendt C, Vrijens F, Schillemans V, Camberlin C, Silversmit G, Stordeur S, Van Eycken E, Dubois C, Robays J, Wauters I, Van Meerbeeck J P
KCE - Belgian Health Care Knowledge Centre, Brussels, Belgium.
Belgian Cancer Registry, Brussels, Belgium.
Eur J Cancer Care (Engl). 2018 Jan;27(1). doi: 10.1111/ecc.12747. Epub 2017 Aug 18.
Guidelines recommend surgery for Stage I-II, chemoradiation for Stage III and systemic therapy for Stage IV non-small cell lung cancer (NSCLC). However, patient related factors and patient preferences influence treatment decisions. We investigated patterns of care for Belgian NSCLC patients in 2010-2011, based on population-based data from the Belgian Cancer Registry and administrative databases. The relationship between patient characteristics, institutional diagnostic volume, type of treatment and survival was investigated. Overall, 20.8% of patients received no oncological treatment. 59% and 22.1% of Stage I-II patients received primary surgery or (chemo)radiation respectively. 34% of Stage III patients received chemoradiation and 17% of Stage IIIA patients had surgery. 70% of Stage IV patients received chemotherapy or targeted therapy. Moderate variability between centres was observed. For Stage IV, systemic therapy was less frequently used in higher volume centres and 1-year survival was lower in centres that had ≥ 50 new patients yearly. Although not all NSCLC patients received treatment as ideally recommended by guidelines, these results do not necessarily represent poor quality of care as patient characteristics and preferences need to be taken into account. Treatment options targeted towards patients with co-morbidity or unfit patients is warranted to improve outcomes of all NSCLC patients.
指南推荐对Ⅰ - Ⅱ期非小细胞肺癌（NSCLC）进行手术治疗，对Ⅲ期进行放化疗，对Ⅳ期进行全身治疗。然而，患者相关因素和患者偏好会影响治疗决策。我们基于比利时癌症登记处和行政数据库的人群数据，调查了2010 - 2011年比利时NSCLC患者的治疗模式。研究了患者特征、机构诊断量、治疗类型与生存率之间的关系。总体而言，20.8%的患者未接受肿瘤治疗。Ⅰ - Ⅱ期患者中，分别有59%和22.1%接受了初次手术或（放）化疗。Ⅲ期患者中有34%接受了放化疗，ⅢA期患者中有17%进行了手术。Ⅳ期患者中有70%接受了化疗或靶向治疗。各中心之间存在适度差异。对于Ⅳ期患者，在诊断量较高的中心，全身治疗的使用频率较低，而每年有≥50名新患者的中心，其1年生存率较低。尽管并非所有NSCLC患者都按照指南理想推荐的方式接受治疗，但这些结果不一定代表医疗质量差，因为需要考虑患者特征和偏好。有必要针对合并症患者或身体状况不佳的患者提供治疗选择，以改善所有NSCLC患者的治疗效果。
