Harvard Medical School.
Dana-Farber Cancer Institute, and.
J Natl Compr Canc Netw. 2020 May;18(5):547-554. doi: 10.6004/jnccn.2019.7384.
Among patients diagnosed with stage IA non-small cell lung cancer (NSCLC), the incidence of occult brain metastasis is low, and several professional societies recommend against brain imaging for staging purposes. The goal of this study was to characterize the use of brain imaging among Medicare patients diagnosed with stage IA NSCLC.
Using data from linked SEER-Medicare claims, we identified patients diagnosed with AJCC 8th edition stage IA NSCLC in 2004 through 2013. Patients were classified as having received brain imaging if they underwent head CT or brain MRI from 1 month before to 3 months after diagnosis. We identified factors associated with receipt of brain imaging using multivariable logistic regression.
Among 13,809 patients with stage IA NSCLC, 3,417 (25%) underwent brain imaging at time of diagnosis. The rate of brain imaging increased over time, from 23.5% in 2004 to 28.7% in 2013 (P=.0006). There was significant variation in the use of brain imaging across hospital service areas, with rates ranging from 0% to 64.0%. Factors associated with a greater likelihood of brain imaging included older age (odds ratios [ORs] of 1.16 for 70-74 years, 1.13 for 75-79 years, 1.31 for 80-84 years, and 1.46 for ≥85 years compared with 65-69 years; all P<.05), female sex (OR, 1.09; P<.05), black race (OR 1.23; P<.05), larger tumor size (ORs of 1.23 for 11-20 mm and 1.28 for 21-30 mm tumors vs 1-10 mm tumors; all P<.05), and higher modified Charlson-Deyo comorbidity score (OR, 1.28 for score >1 vs score of 0; P<.05).
Roughly 1 in 4 patients with stage IA NSCLC received brain imaging at the time of diagnosis despite national recommendations against the practice. Although several patient factors are associated with receipt of brain imaging, there is significant geographic variation across the United States. Closer adherence to clinical guidelines is likely to result in more cost-effective care.
在诊断为 I 期非小细胞肺癌 (NSCLC) 的患者中，隐匿性脑转移的发生率较低，因此一些专业协会建议不为分期目的进行脑部影像学检查。本研究旨在描述 Medicare 诊断为 I 期 NSCLC 患者的脑部影像学检查使用情况。
我们使用来自 SEER-Medicare 数据链接的资料，在 2004 年至 2013 年期间，根据 AJCC 第 8 版诊断为 I 期 NSCLC 的患者。如果患者在诊断后 1 个月内至 3 个月内进行过头 CT 或脑部 MRI，则将其分类为接受脑部影像学检查。我们使用多变量逻辑回归识别与接受脑部影像学检查相关的因素。
在 13809 例 I 期 NSCLC 患者中，有 3417 例（25%）在诊断时进行了脑部影像学检查。脑部影像学检查的比例随着时间的推移而增加，从 2004 年的 23.5%增加到 2013 年的 28.7%（P=.0006）。在不同的医院服务区域，脑部影像学检查的使用情况存在显著差异，范围从 0%到 64.0%。与更有可能进行脑部影像学检查相关的因素包括年龄较大（与 65-69 岁相比，70-74 岁的比值比 [OR]为 1.16，75-79 岁的 OR 为 1.13，80-84 岁的 OR 为 1.31，≥85 岁的 OR 为 1.46；所有 P<.05），女性（OR，1.09；P<.05），黑人种族（OR，1.23；P<.05），肿瘤较大（11-20mm 和 21-30mm 肿瘤的 OR 分别为 1.23 和 1.28，而 1-10mm 肿瘤的 OR 为 1；所有 P<.05），和更高的改良 Charlson-Deyo 合并症评分（评分>1 的 OR 为 1.28，评分 0 的 OR 为 1.0；所有 P<.05）。
尽管有国家建议反对这种做法，但大约有 1/4 的 I 期 NSCLC 患者在诊断时接受了脑部影像学检查。尽管有几个患者因素与接受脑部影像学检查有关，但全美各地存在明显的地域差异。更严格地遵守临床指南可能会导致更具成本效益的治疗。
