a Department of Radiation Oncology , City of Hope National Medical Center , Duarte , CA , USA.
b Department of Radiation Oncology , Allegheny General Hospital , Pittsburgh , PA , USA.
Acta Oncol. 2019 Aug;58(8):1095-1101. doi: 10.1080/0284186X.2019.1599138. Epub 2019 Apr 8.
Early mortality is a major deterrent to oncologic management, often preventing delivery of therapy or leading to administration of treatment that offers limited benefit from aggressive interventions. Due to more recent progress in therapeutic options for stage IV non-small cell lung cancer (NSCLC) patients, identifying those at high risk of early mortality (within 30 days) could have implications for treatment selection. Because early mortality following diagnosis of metastatic non-small cell lung cancer (NSCLC) is not well-characterized, this investigation evaluated national trends and predictors thereof. The National Cancer Database was queried for cases of pathologically confirmed metastatic NSCLC with complete vital status and clinical information, diagnosed between 2006 and 2014. Multivariable logistic regression ascertained factors associated with 30-day mortality. Of 346,681 patients, 45,861 (13%) experienced early mortality over the past decade, which remained relatively constant over time. Predictors of early mortality included advancing age (>65 years), male gender, Caucasian race, non-private insurance, lower income, greater comorbidities, residence in metropolitan and/or lesser-educated areas, treatment at community centers, patients with no prior history of cancer and regional differences ( < .01 for all). Early mortality was highest in patients older than 80 years with multiple comorbidities (29%). The majority of patients (71%) who died within 30 days did not receive any therapy. A fair proportion of NSCLC patients experience early mortality, which has not decreased over time. The majority of patients with early mortality do not receive treatment. Prognostic factors for early mortality should be considered during initial evaluation and subsequent follow-up of these patients. Doing so may impact systemic treatment selection by medical oncologists, management of (oligo)metastatic disease by radiation and surgical oncologists and cost-effective administration of these therapies in the stage IV NSCLC population.
早期死亡率是肿瘤治疗的主要障碍，通常会阻止治疗的实施，或者导致采用治疗方法，但这些方法从激进干预中获益有限。由于最近在 IV 期非小细胞肺癌 (NSCLC) 患者的治疗选择方面取得了进展，因此确定那些具有高早期死亡率（30 天内）风险的患者可能对治疗选择具有重要意义。由于转移性非小细胞肺癌 (NSCLC) 诊断后的早期死亡率尚未得到很好的描述，因此本研究评估了全国范围内的趋势及其预测因素。使用国家癌症数据库 (National Cancer Database) 对 2006 年至 2014 年间经病理证实的转移性 NSCLC 病例进行了检索，这些病例具有完整的生存状态和临床信息。多变量逻辑回归确定了与 30 天死亡率相关的因素。在 346681 名患者中，过去十年中有 45861 名（13%）发生了早期死亡，且该比例在过去十年中相对稳定。早期死亡的预测因素包括年龄较大（>65 岁）、男性、白种人、非私人保险、低收入、合并症较多、居住在大都市和/或教育程度较低的地区、在社区中心接受治疗、无既往癌症史和区域差异（所有因素均 < .01）。年龄在 80 岁以上且合并症较多的患者（29%）早期死亡率最高。在 30 天内死亡的大多数患者（71%）未接受任何治疗。相当一部分 NSCLC 患者（30%）发生早期死亡，且该比例并未随时间降低。大多数早期死亡的患者未接受治疗。在评估这些患者时，应考虑早期死亡率的预测因素，并在后续随访中进行考虑。这样做可能会影响医学肿瘤学家对全身治疗的选择、放射和外科肿瘤学家对（寡）转移性疾病的治疗管理，以及在 IV 期 NSCLC 人群中这些治疗的成本效益管理。
