Department of Radiation Oncology, Martin Luther University, Halle, Germany.
Institute of Medical Epidemiology, Biometry and Informatics, Martin Luther University Halle-Wittenberg, Magdeburger Strasse 24, 06114, Halle (Saale), Germany.
J Cancer Res Clin Oncol. 2019 Nov;145(11):2813-2822. doi: 10.1007/s00432-019-03013-y. Epub 2019 Sep 6.
Stereotactic body radiotherapy (SBRT) can achieve high tumour control with limited toxicity for inoperable early stage non-small-cell lung cancer (NSCLC) patients.
The German Epidemiologic Cancer Registries from the Robert-Koch Institute were assessed. Periods according to the availability of SBRT were: (1) 2000-2003 (pre-SBRT); (2) 2004-2007 (interim); and (3) 2007-2014 (broad availability of SBRT). To assess the association of cancer-related parameters with mortality, hazard ratios (HR) from Cox proportional hazards models were computed. To evaluate the change of treatment-related mortality, we performed interaction analyses and the relative excess risk due to interaction (RERI, additive scale) was computed.
A total of 16,292 patients with UICC stage I NSCLC diagnosed between 2000 and 2014 were analysed. Radiotherapy utilization increased from 5% in pre-SBRT era to 8.8% after 2007. In univariate analyses, survival in the whole cohort improved only marginally when 2000-2003 is compared to 2004-2007 (HR 0.92, 95% CI 0.85-1.01) or 2008-2014 (HR 0.93, 95% CI 0.86-1.01). Comparing surgery/radiotherapy, mortality in the radiotherapy group started from a 3.5-fold risk in 2000-2003 to 2.6 after 2007. The interaction analysis revealed a stronger improvement for radiotherapy (multiplicative scale for 2000-2003 vs. > 2007: 0.74, 95% CI 0.58-0.94). On an additive scale, treatment × period interaction revealed an RERI for 2000-2003 vs. > 2007 of - 1.18 (95% CI - 1.8, - 0.55).
Using population-based data, we observed a survival improvement in stage I lung cancer over time. With an increasing utilization of radiotherapy, a stronger improvement occurred in patients treated with radiotherapy when compared to surgery.
立体定向体部放疗（SBRT）可实现高肿瘤控制率，同时对不可手术的早期非小细胞肺癌（NSCLC）患者的毒性有限。
评估了罗伯特·科赫研究所的德国癌症流行病学登记处的数据。根据 SBRT 的可用性，时间段分为：（1）2000-2003 年（SBRT 前）；（2）2004-2007 年（中期）；（3）2007-2014 年（广泛应用 SBRT）。为了评估癌症相关参数与死亡率的关系，使用 Cox 比例风险模型计算了风险比（HR）。为了评估治疗相关死亡率的变化，我们进行了交互分析，并计算了交互的相对超额风险（RERI，加性尺度）。
分析了 2000 年至 2014 年间诊断为 UICC Ⅰ期 NSCLC 的 16292 例患者。放疗使用率从 SBRT 前时代的 5%增加到 2007 年后的 8.8%。在单因素分析中，与 2004-2007 年或 2008-2014 年相比，2000-2003 年整个队列的生存仅略有改善（HR 0.92，95%CI 0.85-1.01）。比较手术/放疗，放疗组的死亡率在 2000-2003 年开始时的风险是手术组的 3.5 倍，而在 2007 年后降至 2.6 倍。交互分析显示，放疗的改善更强（2000-2003 年与>2007 年的乘法尺度：0.74，95%CI 0.58-0.94）。在加性尺度上，治疗×时期的交互作用显示 2000-2003 年与>2007 年的 RERI 为-1.18（95%CI-1.8，-0.55）。
使用基于人群的数据，我们观察到随着时间的推移，Ⅰ期肺癌的生存率有所提高。随着放疗使用率的增加，与手术相比，接受放疗的患者的改善更为明显。
