Johnston Amy, Creighton Nicola, Parkinson Jonathon, Koh Eng-Siew, Wheeler Helen, Hovey Elizabeth, Rodriguez Michael, Currow David C
Cancer Institute NSW, Sydney, Australia.
The Brain Cancer Group, Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, St Leonards, NSW, Australia.
Neurooncol Pract. 2020 Jan;7(1):22-30. doi: 10.1093/nop/npz021. Epub 2019 Jul 6.
Translating outcomes achieved by clinical trials into routine care is crucial to improving outcomes of glioblastoma (GBM). This study examines the extent to which an advance in treatment for GBM has translated into meaningful, population-level survival benefits in New South Wales (NSW), Australia.
This retrospective cohort study used linked population-based cancer registry, admitted patient, and mortality datasets. The cohort (n = 2604) included NSW residents aged ≥18 years with a histologically confirmed GBM and a surgical resection between July 2001 and December 2012. The study outcome was all-cause survival, examined using multivariable proportional hazard models. The main study factor was period of surgery, categorized into 4 periods corresponding to different eras in temozolomide (TMZ) use. Survival was examined over time by age (≤70 and >70 years) and for a subcohort selected to approximate the seminal European Organisation for Research and Treatment of Cancer (Stupp) protocol trial cohort. TMZ use was estimated using aggregate prescription claims data.
Median survival in 2001-2003, 2004-2006, 2007-2009, and 2010-2012 was 7.4, 9.0, 9.8, and 10.6 months, and risk-adjusted 2-year survival was 8.2%, 13.8%, 15.5%, and 18.3%, respectively. Survival improved for those aged ≤70 years and those aged >70 years. In the proxy trial subcohort, median and 2-year survival were 14.3 months and 27.3%, respectively. The volume of TMZ prescribed annually increased rapidly from 2005.
Introduction of TMZ into standard care in 2005 coincided with improvements in survival and a rapid increase in TMZ prescribing. Optimization of care has continued to improve survival of people with GBM in subsequent years.
将临床试验取得的成果转化为常规治疗对于改善胶质母细胞瘤（GBM）的治疗效果至关重要。本研究考察了GBM治疗方面的一项进展在澳大利亚新南威尔士州（NSW）转化为有意义的、人群水平生存获益的程度。
这项回顾性队列研究使用了基于人群的癌症登记、住院患者和死亡率数据集。队列（n = 2604）包括2001年7月至2012年12月期间年龄≥18岁、组织学确诊为GBM且接受过手术切除的NSW居民。研究结局为全因生存，使用多变量比例风险模型进行分析。主要研究因素为手术时间，分为与替莫唑胺（TMZ）使用的不同时代相对应的4个时间段。按年龄（≤70岁和>70岁）以及为近似开创性的欧洲癌症研究与治疗组织（Stupp）方案试验队列而选取的一个亚队列对生存情况进行长期考察。TMZ的使用通过汇总处方申请数据进行估算。
2001 - 2003年、2004 - 2006年、2007 - 2009年和2010 - 2012年的中位生存期分别为7.4个月、9.0个月、9.8个月和10.6个月，风险调整后的2年生存率分别为8.2%、13.8%、15.5%和18.3%。≤70岁者和>70岁者的生存情况均有所改善。在替代试验亚队列中，中位生存期和2年生存率分别为14.3个月和27.3%。从2005年起，每年TMZ的处方量迅速增加。
2005年将TMZ引入标准治疗与生存情况的改善以及TMZ处方量的迅速增加同时出现。在随后几年中，治疗的优化持续改善了GBM患者的生存情况。
