Division of Medical Oncology, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri.
Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri.
J Thorac Oncol. 2018 Apr;13(4):543-549. doi: 10.1016/j.jtho.2018.01.010. Epub 2018 Feb 2.
Although adjuvant chemotherapy improves survival in patients with completely resected NSCLC, it is also associated with potentially disabling or lethal adverse events. Because there is limited information on the early mortality among patients undergoing adjuvant chemotherapy, we used the National Cancer Database to calculate the percentage of deaths within the first 6 months of starting chemotherapy.
The National Cancer Database was queried for patients age 18 or older in whom stage IB to IIIA NSCLC had been diagnosed between 2004 and 2012 and who had received multiagent adjuvant chemotherapy starting within 120 days from the surgical resection with negative surgical margins. Age groups were divided as follows: younger than 50, 51 to 60, 61 to 70, 71 to 80, and older than 80 years.
A total of 19,691 patients met the eligibility criteria, 19,398 of whom had a known 6-month mortality status. The median age was 65 years (range 19-89). The 1-, 2-, 3-, 4-, 5-, and 6-month cumulative mortality rates from initiation of chemotherapy were 0.7%, 1.3%, 1.9%, 2.6%, 3.2%, and 4.1% respectively. The 6-month mortality rates for each age group (≤ 50 years, 51-60, 61-70, 71-80, and >80) were 2.6%, 3.1%, 4.1%, 5.3%, and 7.6%, respectively (p < 0.001). Independent factors associated with increased 6-month mortality included age 71 to 80 versus younger than 50 (OR = 1.72, 95% confidence interval [CI]: 1.16-2.55, p = 0.007), age older than 80 versus younger than 50 (OR = 2.43, 95% CI: 1.40-4.20, p = 0.002), male sex (OR = 1.42; 95% CI: 1.21-1.67, p < 0.001), Charlson-Deyo comorbidity score of 2 versus 0 (OR = 1.52, 95% CI 1.22-1.89, p < 0.001), pneumonectomy (OR = 1.38, 95% CI: 1.11-1.73, p = 0.004), length of postopertive stay longer than 6 days after surgery (OR = 1.21, 95% CI: 1.03-1.41, p = 0.02), and readmission within 30 days from surgery (OR = 1.48, 95% CI: 1.15-1.90, p = 0.02).
Early mortality with the use of adjuvant chemotherapy after complete resection of NSCLC is a clinical concern. The risk is higher in patients older than 70 years, with higher comorbidity scores and a prolonged length of stay postoperatively.
虽然辅助化疗可提高完全切除 NSCLC 患者的生存率，但也会导致潜在的致残或致命的不良事件。由于关于接受辅助化疗患者的早期死亡率的信息有限，我们使用国家癌症数据库计算了从开始化疗后 6 个月内死亡的百分比。
国家癌症数据库被查询了年龄在 18 岁或以上的患者，这些患者在 2004 年至 2012 年期间被诊断为 IB 至 IIIA 期 NSCLC，并且在手术切缘阴性的情况下，在 120 天内接受了多药辅助化疗。年龄组分为以下几类：小于 50 岁、51 至 60 岁、61 至 70 岁、71 至 80 岁和 80 岁以上。
共有 19691 名患者符合入选标准，其中 19398 名患者已知 6 个月的死亡率。中位年龄为 65 岁（范围 19-89）。从化疗开始后 1、2、3、4、5 和 6 个月的累积死亡率分别为 0.7%、1.3%、1.9%、2.6%、3.2%和 4.1%。每个年龄组（≤ 50 岁、51-60 岁、61-70 岁、71-80 岁和>80 岁）的 6 个月死亡率分别为 2.6%、3.1%、4.1%、5.3%和 7.6%（p<0.001）。与 50 岁以下患者相比，与年龄 71 至 80 岁（比值比[OR]1.72，95%置信区间[CI]1.16-2.55，p=0.007）和年龄大于 80 岁（OR 2.43，95%CI 1.40-4.20，p=0.002）相关的 6 个月死亡率增加是独立的危险因素，男性（OR 1.42；95%CI 1.21-1.67，p<0.001）、Charlson-Deyo 合并症评分 2 分（OR 1.52，95%CI 1.22-1.89，p<0.001）、肺切除术（OR 1.38，95%CI 1.11-1.73，p=0.004）、术后住院时间延长（OR 1.21，95%CI 1.03-1.41，p=0.02）和术后 30 天内再次入院（OR 1.48，95%CI 1.15-1.90，p=0.02）。
完全切除 NSCLC 后使用辅助化疗的早期死亡率是一个临床关注的问题。在年龄大于 70 岁的患者、合并症评分较高和术后住院时间较长的患者中，风险更高。
