肺癌治疗进展对人群死亡率的影响。
The Effect of Advances in Lung-Cancer Treatment on Population Mortality.
机构信息
From the Surveillance Research Program, Division of Cancer Control and Population Sciences (N.H., G.F., K.A.C., A.B.M., E.J.F.) and Office of the Director (D.R.L.), National Cancer Institute, Bethesda, MD; Massachusetts General Hospital, Harvard Medical School, Boston (M.J.M., C.Y.K.); and the Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor (R.M.).
出版信息
N Engl J Med. 2020 Aug 13;383(7):640-649. doi: 10.1056/NEJMoa1916623.
BACKGROUND
Lung cancer is made up of distinct subtypes, including non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC). Although overall mortality from lung cancer has been declining in the United States, little is known about mortality trends according to cancer subtype at the population level because death certificates do not record subtype information.
METHODS
Using data from Surveillance, Epidemiology, and End Results (SEER) areas, we assessed lung-cancer mortality and linked deaths from lung cancer to incident cases in SEER cancer registries. This allowed us to evaluate population-level mortality trends attributed to specific subtypes (incidence-based mortality). We also evaluated lung-cancer incidence and survival according to cancer subtype, sex, and calendar year. Joinpoint software was used to assess changes in incidence and trends in incidence-based mortality.
RESULTS
Mortality from NSCLC decreased even faster than the incidence of this subtype, and this decrease was associated with a substantial improvement in survival over time that corresponded to the timing of approval of targeted therapy. Among men, incidence-based mortality from NSCLC decreased 6.3% annually from 2013 through 2016, whereas the incidence decreased 3.1% annually from 2008 through 2016. Corresponding lung cancer-specific survival improved from 26% among men with NSCLC that was diagnosed in 2001 to 35% among those in whom it was diagnosed in 2014. This improvement in survival was found across all races and ethnic groups. Similar patterns were found among women with NSCLC. In contrast, mortality from SCLC declined almost entirely as a result of declining incidence, with no improvement in survival. This result correlates with limited treatment advances for SCLC in the time frame we examined.
CONCLUSIONS
Population-level mortality from NSCLC in the United States fell sharply from 2013 to 2016, and survival after diagnosis improved substantially. Our analysis suggests that a reduction in incidence along with treatment advances - particularly approvals for and use of targeted therapies - is likely to explain the reduction in mortality observed during this period.
背景
肺癌由不同的亚型组成，包括非小细胞肺癌（NSCLC）和小细胞肺癌（SCLC）。尽管美国肺癌的总体死亡率一直在下降，但由于死亡证明不记录亚型信息，因此对人群水平根据癌症亚型的死亡率趋势知之甚少。
方法
使用来自监测、流行病学和最终结果（SEER）区域的数据，我们评估了肺癌死亡率，并将肺癌死亡与 SEER 癌症登记处的发病病例相关联。这使我们能够评估归因于特定亚型（基于发病率的死亡率）的人群水平死亡率趋势。我们还根据癌症亚型、性别和日历年来评估肺癌的发病率和生存情况。Joinpoint 软件用于评估发病率的变化和基于发病率的死亡率趋势。
结果
NSCLC 的死亡率下降速度甚至超过了该亚型的发病率，这种下降与随着时间的推移生存状况的显著改善有关，这与靶向治疗获得批准的时间相对应。在男性中，2013 年至 2016 年期间，NSCLC 的基于发病率的死亡率每年下降 6.3%，而 2008 年至 2016 年期间每年下降 3.1%。在 2001 年诊断出 NSCLC 的男性中，肺癌特异性生存率从 26%提高到 2014 年诊断出 NSCLC 的男性的 35%。这种生存改善在所有种族和族裔群体中都有发现。在女性 NSCLC 中也发现了类似的模式。相比之下，SCLC 的死亡率几乎完全下降是由于发病率下降，生存状况没有改善。这一结果与我们研究期间 SCLC 治疗进展有限相吻合。
结论
美国 NSCLC 的人群水平死亡率从 2013 年到 2016 年急剧下降，诊断后的生存率大幅提高。我们的分析表明，发病率的下降以及治疗的进步——特别是针对和使用靶向治疗的批准——很可能解释了这一时期观察到的死亡率下降。
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