Department of Radiation Oncology, Baylor College of Medicine, Houston, TX.
Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX.
Clin Lung Cancer. 2018 Mar;19(2):e269-e276. doi: 10.1016/j.cllc.2017.11.004. Epub 2017 Nov 21.
We reviewed the population-based treatment patterns and outcomes for elderly patients with stage I non-small-cell lung cancer (NSCLC) treated from 2004 to 2012.
Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified biopsy-proven stage I NSCLC cases diagnosed from 2004 to 2012. The patients were divided into 5-year age subsets (60-64, 65-69, 70-74, 75-79, 80-84, 85-89, and ≥ 90 years). The demographic data, therapy, and survival were compared by year. Trends in overall survival (OS), cancer-specific survival (CSS), and practice patterns were analyzed.
A total of 62,213 cases were identified. The use of surgery declined sharply with age. Patients aged 60 to 64 years had a surgical rate of 81% compared with 21% for those aged ≥ 90 years (P < .0001). Radiation use increased (from 11% to 39%; P < .0001), as did the receipt of neither surgery nor radiation (from 7% to 40%; P < .0001). When analyzing the annual trends, radiation use increased, with fewer patients forgoing treatment from 2004 to 2012 (P < .0001). From 2004 to 2011, CSS at 2 years improved significantly for patients treated with radiation alone (from 48% to 72%; P < .0001) and more subtly for those receiving surgery alone (from 87% to 91%; P < .0001). The outcomes were stable for those receiving neither surgery nor radiation (38% to 45%; P = NS). Surgical outcomes declined with advancing age (P < .0001); however, the radiation outcomes did not (P = NS).
With advancing age, radiation replaces surgery as the most used treatment for early-stage NSCLC. OS and CSS have improved significantly for elderly stage I NSCLC patients treated with radiation alone during a timeline concurrent with the widespread adoption of stereotactic body radiation therapy. Dedicated prospective studies are indicated, because these findings are limited by the inherent biases of using the SEER database alone.
我们回顾了 2004 年至 2012 年间，接受治疗的 I 期非小细胞肺癌（NSCLC）老年患者的基于人群的治疗模式和结局。
利用监测、流行病学和最终结果（SEER）数据库，我们确定了 2004 年至 2012 年间经活检证实的 I 期 NSCLC 病例。将患者分为 5 岁年龄亚组（60-64、65-69、70-74、75-79、80-84、85-89 和≥90 岁）。通过年度比较，比较了人口统计学数据、治疗和生存情况。分析了总生存（OS）、癌症特异性生存（CSS）和实践模式的趋势。
共确定了 62213 例病例。手术使用率随年龄增长急剧下降。60-64 岁患者的手术率为 81%，而≥90 岁患者的手术率为 21%（P<0.0001）。放疗使用率增加（从 11%增至 39%；P<0.0001），未接受手术和放疗的患者比例也增加（从 7%增至 40%；P<0.0001）。分析年度趋势时，放疗使用率增加，2004 年至 2012 年期间，放弃治疗的患者减少（P<0.0001）。从 2004 年至 2011 年，单独接受放疗的患者 CSS 从 2 年的 48%提高到 72%（P<0.0001），单独接受手术的患者 CSS 则从 87%提高到 91%（P<0.0001）。既未接受手术也未接受放疗的患者的结局保持稳定（从 38%到 45%；P=NS）。手术结果随年龄增长而下降（P<0.0001）；然而，放疗结果并非如此（P=NS）。
随着年龄的增长，放疗作为治疗早期 NSCLC 的最常用方法取代了手术。在广泛采用立体定向体部放射治疗的同时，单独接受放疗的老年 I 期 NSCLC 患者的 OS 和 CSS 显著改善。由于这些发现受到仅使用 SEER 数据库的固有偏差的限制，因此需要进行专门的前瞻性研究。
