Division of Medical Oncology, National Cancer Centre, Singapore, Singapore.
Ann Acad Med Singap. 2017 Sep;46(9):333-338.
We reviewed changes in clinical characteristics, treatment and survival of lung cancer patients in Singapore over the past decade.
We reviewed all primary lung cancer cases from January 2004 to December 2013. Basic demographic, clinical and treatment data were extracted from the database. Overall survival (OS) was calculated using Kaplan-Meier method; survival curves were compared using log-rank test. Linear regression trend lines were estimated using least squares approach, and Cox regression analyses were performed to identify prognostic factors.
Among 6006 lung cancer patients, the median age was 68 years old, 65% were males, 88% were Chinese, 92% had non-small-cell lung cancer and 76% had advanced stage IIIB/IV. There were proportionally more adenocarcinomas diagnosed over the years, while that of squamous cell carcinoma (SCC) and small-cell-lung cancer (SCLC) have remained stable. The median OS of all patients increased from 9.2 months in 2004 to 11.5 months in 2013. This survival improvement was statistically significant among patients with stage IIIB/IV (6.7 to 8.7 months; = 0.005) and adenocarcinoma (12.7 to 15.4 months; = 0.041). There was no improvement in median OS for SCC or SCLC. The use of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKI) (hazard ratio [HR] 0.68; 95% CI, 0.63 to 0.73) and pemetrexed (HR, 0.69; 95% CI, 0.63 to 0.76) were significantly associated with improved OS.
Survival of patients with advanced stage IIIB/IV lung adenocarcinoma has improved over the past decade, and is potentially associated with the use of EGFR TKI and pemetrexed.
我们回顾了过去十年中新加坡肺癌患者的临床特征、治疗方法和生存情况的变化。
我们回顾了 2004 年 1 月至 2013 年 12 月期间所有原发性肺癌病例。从数据库中提取了基本人口统计学、临床和治疗数据。使用 Kaplan-Meier 法计算总生存期（OS）；使用对数秩检验比较生存曲线。使用最小二乘法估计线性回归趋势线，并进行 Cox 回归分析以确定预后因素。
在 6006 例肺癌患者中，中位年龄为 68 岁，65%为男性，88%为中国人，92%为非小细胞肺癌，76%为晚期 IIIB/IV 期。近年来，腺癌的诊断比例有所增加，而鳞状细胞癌（SCC）和小细胞肺癌（SCLC）的比例则保持稳定。所有患者的中位 OS 从 2004 年的 9.2 个月增加到 2013 年的 11.5 个月。这种生存改善在 IIIB/IV 期（6.7 至 8.7 个月；=0.005）和腺癌（12.7 至 15.4 个月；=0.041）患者中具有统计学意义。SCC 或 SCLC 的中位 OS 无改善。表皮生长因子受体酪氨酸激酶抑制剂（EGFR TKI）（风险比[HR]0.68；95%置信区间，0.63 至 0.73）和培美曲塞（HR，0.69；95%置信区间，0.63 至 0.76）的使用与 OS 改善显著相关。
过去十年中，晚期 IIIB/IV 期肺腺癌患者的生存状况有所改善，这可能与 EGFR TKI 和培美曲塞的使用有关。
