Department of Surgery, Amphia Hospital, Breda, The Netherlands.
Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands; Department of Epidemiology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.
Eur J Cancer. 2018 Sep;101:30-37. doi: 10.1016/j.ejca.2018.06.016. Epub 2018 Jul 14.
The optimal treatment of elderly patients with early-stage non-small-cell lung cancer (NSCLC) remains elusive. Still, the introduction of video-assisted thoracic surgery (VATS) and stereotactic body radiotherapy (SBRT) may have led to more elderly receiving treatment and improved median overall survival (OS).
We analysed data from the Netherlands Cancer Registry of 2168 patients ≥65 years with clinical stage I NSCLC and distinguished two periods: 2004-2008 (A) and 2009-2013 (B). The analyses focussed on treatment patterns and median OS for patients receiving surgery, radiotherapy or neither surgery nor radiotherapy. Furthermore, we explored the influence of the application of VATS and SBRT.
The resection rate did not differ between the periods A and B (51% versus 53%; p = 0.37), despite significantly more VATS procedures in the latter period (0% versus 32%; p < 0.001). Application of radiotherapy increased (26% versus 33%; p = 0.001), especially SBRT (3% versus 63%; p < 0.001). The proportion of patients receiving neither therapy decreased (23% versus 14%; p < 0.001). Median OS for all patients significantly improved (31 versus 42 months; p = 0.001), and also for those receiving radiotherapy (23 versus 33 months; p = 0.02), but not significantly for surgical patients (65 versus 74 months; p = 0.16). Still, in multivariable analysis, surgical patients had an increased risk of death in period A compared with period B (hazard ratio [HR] 1.20; 95% confidence interval [CI], 1.01-1.43); this was not the case for patients receiving radiotherapy (HR 1.19; 95% CI, 0.99-1.43). Five-year OS was 57% for surgical patients and 23% for those receiving radiotherapy.
In elderly patients with stage I NSCLC, the use of surgery remained constant, that of radiotherapy increased and fewer patients received neither treatment over the years. Median OS improved for all patients; surgery was associated with the highest long-term OS.
对于早期非小细胞肺癌（NSCLC）的老年患者，最佳治疗方法仍不明确。然而，电视辅助胸腔镜手术（VATS）和立体定向体部放射治疗（SBRT）的应用可能使更多的老年患者接受治疗，并提高中位总生存期（OS）。
我们分析了荷兰癌症登记处 2168 例年龄≥65 岁、临床分期为 I 期 NSCLC 患者的数据，并将其分为两个时期：2004-2008 年（A 期）和 2009-2013 年（B 期）。分析重点为接受手术、放疗或两者均不接受治疗的患者的治疗模式和中位 OS。此外，我们还探讨了 VATS 和 SBRT 的应用对结果的影响。
尽管 B 期 VATS 手术的比例显著增加（0%至 32%；p<0.001），但 A 期和 B 期的手术切除率并无差异（51%比 53%；p=0.37）。放疗的应用有所增加（26%比 33%；p=0.001），尤其是 SBRT（3%比 63%；p<0.001）。不接受任何治疗的患者比例减少（23%比 14%；p<0.001）。所有患者的中位 OS 显著提高（31 个月比 42 个月；p=0.001），接受放疗的患者中位 OS 也显著提高（23 个月比 33 个月；p=0.02），但手术患者的中位 OS 提高不显著（65 个月比 74 个月；p=0.16）。然而，多变量分析显示，与 B 期相比，A 期手术患者的死亡风险增加（风险比 [HR] 1.20；95%置信区间 [CI]，1.01-1.43）；接受放疗的患者则不然（HR 1.19；95%CI，0.99-1.43）。手术患者的 5 年 OS 为 57%，接受放疗的患者为 23%。
在 I 期 NSCLC 老年患者中，手术的应用保持稳定，放疗的应用增加，多年来接受治疗和不接受治疗的患者比例减少。所有患者的中位 OS 均有所提高；手术与最高的长期 OS 相关。
