Kapadia Nirav S, Valle Luca F, George Julie A, Jagsi Reshma, D'Amico Thomas A, Dexter Elisabeth U, Vigneau Fawn D, Kong Feng Ming
Norris Cotton Cancer Center at Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.
The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Ann Thorac Surg. 2017 Dec;104(6):1881-1888. doi: 10.1016/j.athoracsur.2017.06.065. Epub 2017 Oct 26.
Definitive surgical and radiation therapy (RT) treatments are evolving rapidly for stage I non-small cell lung cancer (NSCLC). We hypothesized that utilization of definitive therapies increased between 2000 and 2010 and that survival improved for stage I NSCLC patients over the same time period. Secondary objectives were determining trends in patterns of care and predictors of utilization.
Population-based, observational, comparative effectiveness study used Surveillance, Epidemiology, and End Results-18 data from 2000 to 2010. The main outcome measure was 2-year risk of death for stage I NSCLC.
Between 2000 and 2010, 40,589 patients (62%) underwent surgery, 10,048 (15%) received RT, 2,130 (3%) received both surgery and RT, and 11,537 (18%) received neither surgery nor RT. Annually, the odds of receiving either definitive RT or undergoing surgery increased relative to the odds of receiving no treatment (odds ratio [OR] radiation 1.04, 95% confidence interval [CI]: 1.03 to 1.05; OR surgery 1.05, 95% CI: 1.04 to 1.05). Among surgical patients, the proportion of sublobar resections steadily increased from 12.9% to 17.9%. For all patients, the 2-year risk of death decreased by 3.5% each year (hazard ratio [HR] 0.965, 95% CI: 0.962 to 0.969), driven primarily by improved survival for surgical (annualized HR 0.959, 95% CI: 0.954 to 0.964) and RT (annualized HR 0.942, 95% CI: 0.935 to 0.949) patients.
Between 2000 and 2010, stage I NSCLC patients were more likely to receive definitive treatment with either surgery or RT, leading to a decline in the number of untreated patients. Survival also improved substantially for stage I NSCLC patients, with the largest survival improvements observed in patients undergoing definitive RT.
I 期非小细胞肺癌（NSCLC）的确定性手术和放射治疗（RT）正在迅速发展。我们假设在 2000 年至 2010 年间，确定性治疗的使用率有所增加，并且同期 I 期 NSCLC 患者的生存率有所提高。次要目标是确定护理模式的趋势和使用的预测因素。
基于人群的观察性比较有效性研究使用了 2000 年至 2010 年的监测、流行病学和最终结果 - 18 数据。主要结局指标是 I 期 NSCLC 的 2 年死亡风险。
在 2000 年至 2010 年间，40,589 名患者（62%）接受了手术，10,048 名（15%）接受了 RT，2,130 名（3%）接受了手术和 RT，11,537 名（18%）既未接受手术也未接受 RT。每年，接受确定性 RT 或手术的几率相对于未接受治疗的几率有所增加（优势比 [OR] 放疗 1.04，95% 置信区间 [CI]：1.03 至 1.05；OR 手术 1.05，95% CI：1.04 至 1.05）。在手术患者中，亚肺叶切除的比例从 12.9% 稳步增加到 17.9%。对于所有患者，2 年死亡风险每年下降 3.5%（风险比 [HR] 0.965，95% CI：0.962 至 0.969），这主要是由于手术患者（年化 HR 0.959，95% CI：0.954 至 0.964）和 RT 患者（年化 HR 0.942，95% CI：0.935 至 0.949）生存率的提高。
在 2000 年至 2010 年间，I 期 NSCLC 患者更有可能接受手术或 RT 的确定性治疗，导致未治疗患者数量减少。I 期 NSCLC 患者的生存率也有显著提高，在接受确定性 RT 的患者中观察到最大的生存改善。
