Yu Chin-Hsiu, Cheng Ya-Ai, Chen Ru-Yih, Wu Yu-Lung, Lin Min-Hsi
Department of Information Engineering, I-Shou University, Kaohsiung, Taiwan.
Department of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan.
Cancer Manag Res. 2020 Dec 16;12:12957-12964. doi: 10.2147/CMAR.S282481. eCollection 2020.
To explore whether antineoplastic treatment can improve overall survival (OS) in older patients with metastatic non-small-cell lung cancer (mNSCLC).
Using the cancer registry database of a tertiary medical center in Taiwan, we followed patients 65 years old and above with pathologically proved mNSCLC. Chi-square test and Cox regression were used to analyze differences in clinical characteristics, the treatments they received, and factors predicting survival. Kaplan-Meier survival analysis was used to analyze OS differences.
A total of 542 older patients were diagnosed with mNSCLC from 2011 to 2017. Multivariate Cox regression showed that patients receiving targeted therapy (TT) alone, chemotherapy (CT) alone, and crossover (CO) treatment were at significantly less risk of short OS [hazard ratio (HR) 0.351, 95% confidence interval (CI), 0.257-0.479; HR 0.517, CI 0.376-0.711; and HR 0.544, CI 0.373-0.792, respectively]. Patients at significantly increased risk of short OS were those aged ≥85 years and those assigned poorer Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores (HR 1.513, CI 1.135-2.017, and HR 2.854, CI 2.188-3.724, respectively). The result of Kaplan-Meier survival analysis of 418 patients with ECOG-PS scores 0-2 suggested that patients who received antineoplastic treatments had a significantly better median OS than those receiving supportive care (SC), those receiving TT having the best result (SC, 4.00 months; TT, 21.17 months; CT, 12.83 months; CO, 15.83 months, P<0.001).
Antineoplastic treatments, especially TT, can improve OS for selected older patients with mNSCLC.
探讨抗肿瘤治疗能否改善老年转移性非小细胞肺癌（mNSCLC）患者的总生存期（OS）。
利用台湾某三级医疗中心的癌症登记数据库，我们对65岁及以上经病理证实为mNSCLC的患者进行了随访。采用卡方检验和Cox回归分析临床特征、接受的治疗以及生存预测因素的差异。采用Kaplan-Meier生存分析来分析总生存期的差异。
2011年至2017年共有542例老年患者被诊断为mNSCLC。多因素Cox回归显示，单纯接受靶向治疗（TT）、单纯接受化疗（CT）以及交叉（CO）治疗的患者短期总生存期风险显著降低[风险比（HR）分别为0.351，95%置信区间（CI）为0.257 - 0.479；HR 0.517，CI 0.376 - 0.711；HR 0.544，CI 0.373 - 0.792]。短期总生存期风险显著增加的患者为年龄≥85岁以及东部肿瘤协作组体能状态（ECOG-PS）评分较差的患者（HR分别为1.513，CI 1.135 - 2.017；HR 2.854，CI 2.188 - 3.724）。对418例ECOG-PS评分为0 - 2的患者进行Kaplan-Meier生存分析的结果表明，接受抗肿瘤治疗的患者中位总生存期显著优于接受支持治疗（SC）的患者，接受TT治疗的患者结果最佳（SC组为4.00个月；TT组为21.17个月；CT组为12.83个月；CO组为15.83个月，P<0.001）。
抗肿瘤治疗，尤其是TT，可改善部分老年mNSCLC患者的总生存期。
