Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Epidemiology, Maastricht University Medical Centre+, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands.
Department of Surgery, Amphia Hospital, Breda, the Netherlands.
J Geriatr Oncol. 2019 Jul;10(4):547-554. doi: 10.1016/j.jgo.2019.03.001. Epub 2019 Mar 12.
Insights regarding utilization and survival of surgery and radiotherapy (stereotactic body radiotherapy (SBRT) or conventional radiotherapy (RT)) are lacking for older patients with stage I and II non-small cell lung cancer (NSCLC) in clinical practice.
Data from the Netherlands Cancer Registry were retrieved for patients ≥65 years with clinical stage I-II NSCLC in 2010-2015. Descriptive analyses, overall survival (OS), and cox regression were stratified for stage I (n = 8742) and II (n = 3439) and compared age groups (65-74 years vs ≥75 years).
Patients aged 65-74 underwent surgery significantly more often compared to those aged ≥75 (stage I 55% vs 27%; stage II: 65% vs 35%), and received SBRT less often (I: 29% vs 42%; II: 5% vs 11%), conventional RT less often (I: 6% vs 11%; II 10% vs 24%) and best supportive care alone less often (BSC, I: 8% vs 19%; II: 9% vs 25%). One-year OS was significantly higher in patients aged 65-74 compared to those aged ≥75 (I: 87% vs 78%; II: 74% vs 60%); as was five-year OS (I: 49% vs 31%; II: 36% vs 18%). After adjustment for gender, histology, stage, treatment, and comorbidity, hazard ratio (HR) of death was higher for patients aged ≥75 compared to those aged 65-74 (I: HR 1.3, 95% confidence interval (CI) 1.1-1.5; II: HR 1.3 95%CI 1.1-1.7).
Patients aged ≥75 with stage I-II NSCLC had poorer OS, underwent surgery less often, and received SBRT, conventional RT, and BSC more often than patients aged 65-74. In both stages, one-year OS within age groups was similar for surgery and SBRT. However, long-term OS adjusted for prognostic factors was superior for surgery compared to SBRT and remained poorer for those aged ≥75. Prospective research should focus on predictive characteristics for treatment selection and patient-centered outcomes.
对于临床实践中患有 I 期和 II 期非小细胞肺癌（NSCLC）的老年患者，关于手术和放疗（立体定向体部放疗（SBRT）或常规放疗（RT））的利用和生存情况的信息尚不清楚。
从荷兰癌症登记处检索了 2010-2015 年年龄≥65 岁、临床分期为 I-II 期 NSCLC 的患者数据。对 I 期（n=8742）和 II 期（n=3439）患者进行了描述性分析、总生存期（OS）和 Cox 回归分析，并按年龄组（65-74 岁 vs ≥75 岁）进行了分层比较。
与≥75 岁的患者相比，65-74 岁的患者更常接受手术（I 期 55% vs 27%；II 期：65% vs 35%），接受 SBRT 的频率较低（I 期：29% vs 42%；II 期：5% vs 11%），常规 RT 的频率较低（I 期：6% vs 11%；II 期 10% vs 24%），单独接受最佳支持治疗（BSC）的频率也较低（I 期：8% vs 19%；II 期：9% vs 25%）。与≥75 岁的患者相比，65-74 岁的患者一年 OS 显著更高（I 期：87% vs 78%；II 期：74% vs 60%），五年 OS 也更高（I 期：49% vs 31%；II 期：36% vs 18%）。在校正性别、组织学、分期、治疗和合并症后，与 65-74 岁的患者相比，≥75 岁的患者死亡的风险比（HR）更高（I 期：HR 1.3，95%置信区间（CI）1.1-1.5；II 期：HR 1.3，95%CI 1.1-1.7）。
患有 I 期和 II 期 NSCLC 的≥75 岁患者 OS 较差，手术较少，SBRT、常规 RT 和 BSC 治疗较多，而 65-74 岁患者则较少。在两个分期中，手术和 SBRT 的同年龄组的一年 OS 相似。然而，调整预后因素后的长期 OS 手术优于 SBRT，而≥75 岁患者的 OS 仍较差。前瞻性研究应关注治疗选择和以患者为中心的结局的预测特征。
