Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA.
Greater Bay Area Cancer Registry, Cancer Prevention Institute of California, Fremont, CA.
Clin Lung Cancer. 2018 Sep;19(5):e745-e758. doi: 10.1016/j.cllc.2018.05.009. Epub 2018 Jun 21.
The present study examined clinical stage I non-small-cell lung cancer (NSCLC) treatment in the population-based California Cancer Registry.
The characteristics associated with first clinical stage I NSCLC treatment (surgery, radiation, no local therapy) from 2003 to 2014 were identified using logistic regression. Survival was evaluated using Kaplan-Meier and Cox proportional hazard analyses.
Surgery was used in most patients who met the inclusion criteria (14,545 of 19,893; 73.1%), although relatively similar numbers had undergone radiation (n = 2848; 14.3%) or not received therapy (n = 2500; 12.6%). Surgery use ranged from 68.5% to 77.2% patients annually. The percentage of patients with no therapy decreased from 18.1% (315 of 1737) in 2003 to 10.3% (176 of 1703) in 2014, and radiation use increased from 10.7% (185 of 1737) in 2003 to 21.2% (361 of 1703) in 2014. Patients who did not receive therapy were more likely to be older, not white, male, and unmarried, to have no insurance or public insurance other than Medicare, to live in a lower socioeconomic status neighborhood, to have been seen at a non-National Cancer Institute cancer center hospital or hospital serving lower socioeconomic status patients, and to have larger tumors. The 5-year all-cause survival after no therapy (12.7%) was significantly worse than that after surgery (64.9%) or radiation (21.5%; P < .0001).
In the present population-based analysis, surgery was the most common treatment for clinical stage I NSCLC but was not used for almost 27% of patients. Radiation use increased and the proportion of patients who did not receive any therapy decreased over time.
本研究检查了基于人群的加利福尼亚癌症登记处的Ⅰ期非小细胞肺癌（NSCLC）的临床治疗。
使用逻辑回归确定了 2003 年至 2014 年间与首次Ⅰ期 NSCLC 治疗（手术、放疗、无局部治疗）相关的特征。使用 Kaplan-Meier 和 Cox 比例风险分析评估生存情况。
大多数符合纳入标准的患者（19893 例中有 14545 例；73.1%）接受了手术治疗，但接受放疗（n=2848；14.3%）或未接受治疗（n=2500；12.6%）的患者数量相对相似。手术使用率每年在 68.5%至 77.2%之间。未接受治疗的患者比例从 2003 年的 18.1%（315/1737）降至 2014 年的 10.3%（176/1703），放疗使用率从 2003 年的 10.7%（185/1737）升至 2014 年的 21.2%（361/1703）。未接受治疗的患者更可能年龄较大、非白种人、男性、未婚、无保险或除医疗保险外无其他公共保险、居住在社会经济地位较低的社区、在非国家癌症研究所癌症中心医院或服务于社会经济地位较低的患者的医院就诊，并且肿瘤较大。未接受治疗的 5 年全因生存率（12.7%）明显低于手术（64.9%）或放疗（21.5%；P<0.0001）。
在本基于人群的分析中，手术是治疗Ⅰ期 NSCLC 的最常见方法，但仍有近 27%的患者未接受手术治疗。随着时间的推移，放疗的应用增加，未接受任何治疗的患者比例下降。
