Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
Regional Cancer Center, Uppsala, Sweden.
Lung Cancer. 2020 Jan;139:111-117. doi: 10.1016/j.lungcan.2019.11.008. Epub 2019 Nov 14.
To examine if educational status is associated with outcome in patients with Small Cell Lung Cancer (SCLC). The study also investigated differences in patterns of management (lead times and treatment intensity) between educational levels.
This nationwide cohort study was based on data from Lung Cancer Data Base Sweden (LCBaSe) generated by record linkages between the Swedish National Lung Cancer Register and several other population-based registers. Educational level was categorized by number of years of schooling: low (≤ 9 years), medium (10-12 years) and high (≥ 13 years). Risk of death expressed as hazard ratios (HR) with 95 % confidence interval (CI) were estimated in multi-variable analyses adjusted for age, sex, disease stage at diagnosis, household size and performance status (PS). Analyses stratified by sex and stage were also performed.
The study population encompassed 4256 patients with an SCLC diagnosis between 2002 and 2011. Higher education was associated with a significantly lower risk of death in univariable and multivariable models. The univariable HR comparing high to low level of education was 0.84 (95 % CI: 0.75-0.93), an estimate that was attenuated following adjustments (HR 0.88; 95 % CI: 0.80-0.98). Compared to men with a low level of education, the risk of death was significantly lower in men with a high education; HR 0.84 (95 % CI: 0.73-0.98). In Limited Disease (LD), the prognosis was significantly better in both men and women with high compared low education (HR 0.76; 95 % CI: 0.58-0.98). In Swedish men with SCLC, and among patients with LD-SCLC, a low level of education was associated with a poorer prognosis compared to patients with high education.
研究教育程度与小细胞肺癌（SCLC）患者预后的相关性。本研究还调查了不同教育水平之间管理模式（就诊时间和治疗强度）的差异。
本全国性队列研究基于瑞典肺癌数据库（LCBaSe）的数据，该数据库是通过瑞典国家肺癌登记处与其他几个基于人群的登记处之间的记录链接生成的。教育程度按受教育年限分类：低（≤9 年）、中（10-12 年）和高（≥13 年）。采用多变量分析，调整年龄、性别、诊断时的疾病分期、家庭规模和表现状态（PS），以危险比（HR）表示死亡风险，并计算 95%置信区间（CI）。还按性别和分期进行了分层分析。
本研究人群包括 2002 年至 2011 年间诊断为 SCLC 的 4256 例患者。在单变量和多变量模型中，较高的教育程度与死亡风险显著降低相关。与低教育程度相比，高教育程度的单变量 HR 为 0.84（95%CI：0.75-0.93），调整后（HR 0.88；95%CI：0.80-0.98）有所减弱。与低教育程度的男性相比，高教育程度的男性死亡风险显著降低，HR 为 0.84（95%CI：0.73-0.98）。在局限性疾病（LD）中，高教育程度的男性和女性患者的预后明显优于低教育程度的患者（HR 0.76；95%CI：0.58-0.98）。在瑞典男性 SCLC 患者中，以及 LD-SCLC 患者中，与高教育程度的患者相比，低教育程度与较差的预后相关。
