Section of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand.
Department of Pharmacology and Clinical Pharmacology and Auckland Cancer Society Research Centre, School of Medical Sciences, The University of Auckland, Auckland, New Zealand.
Cancer Epidemiol. 2018 Dec;57:24-32. doi: 10.1016/j.canep.2018.09.004. Epub 2018 Sep 29.
Epidermal Growth Factor Receptor (EGFR) mutation testing is recommended for patients with non-squamous non-small cell lung cancer (NSCLC) but not all eligible patients get tested, which may bias the mutation prevalence estimated. This study aims to examine trends in the uptake of EGFR mutation testing in patients with non-squamous NSCLC in New Zealand; to develop a composite metric that quantifies the influences of demographic and clinico-pathological factors on the testing uptake; and to estimate the prevalence of EGFR mutation if all patients were tested.
This population-based study involved all patients who were diagnosed with non-squamous NSCLC in four health regions in New Zealand between January 2010 and December 2015. Eligible patients were identified from the New Zealand Cancer Registry and information on EGFR mutation testing was obtained through linkage to TestSafe, a clinical information sharing service, and laboratory records.
Of 2701 eligible patients, 1059 (39.2%) were tested for EGFR mutation. The testing prevalence increased (3.7% in 2010 to 64.6% in 2014) and the influences of demographic and clinic-pathological factors decreased from 2010 to June 2014, and remained stable afterward. Of the tested patients, 229 (21.6%) were mutation positive with a decreasing trend observed from 2010 (43.8%) to June 2014 (16.8%). The best-fit log-linear model estimated the prevalence of EGFR mutation, if all patients were tested, as 15.5% (95% CI: 13.2%-18.0%).
The methods described here allowed a more accurate estimation of the prevalence of EGFR mutation.
表皮生长因子受体 (EGFR) 突变检测被推荐用于非鳞状非小细胞肺癌 (NSCLC) 患者，但并非所有符合条件的患者都接受了检测，这可能会影响到对突变流行率的估计。本研究旨在检查新西兰非鳞状 NSCLC 患者 EGFR 突变检测的采用趋势；开发一种综合指标，量化人口统计学和临床病理因素对检测采用的影响；并估计如果所有患者都进行检测，EGFR 突变的流行率。
这项基于人群的研究涉及了在新西兰四个卫生区域于 2010 年 1 月至 2015 年 12 月期间被诊断患有非鳞状 NSCLC 的所有患者。从新西兰癌症登记处确定了符合条件的患者，通过与 TestSafe（一种临床信息共享服务）的链接获取了有关 EGFR 突变检测的信息，TestSafe 是一种临床信息共享服务，以及实验室记录。
在 2701 名符合条件的患者中，有 1059 名（39.2%）接受了 EGFR 突变检测。检测流行率增加（2010 年为 3.7%，2014 年为 64.6%），人口统计学和临床病理因素的影响从 2010 年到 2014 年 6 月逐渐降低，此后保持稳定。在接受检测的患者中，有 229 名（21.6%）突变阳性，从 2010 年（43.8%）到 2014 年 6 月（16.8%）观察到下降趋势。最佳拟合的对数线性模型估计，如果所有患者都进行检测，EGFR 突变的流行率为 15.5%（95%CI：13.2%-18.0%）。
这里描述的方法可以更准确地估计 EGFR 突变的流行率。
