Department of Hematology and Oncology, Medical University of South Carolina, Charleston, SC 29425, USA.
Division of Cardiovascular Research, Saint Luke's Hospital, Kansas City, MO 64111, USA.
Lung Cancer. 2021 Apr;154:62-68. doi: 10.1016/j.lungcan.2021.02.011. Epub 2021 Feb 16.
There are limited data on the role for chemotherapy in patients > 80 years old with advanced stage non-small cell lung carcinoma (NSCLC). We used the National Cancer Database (NCDB) to evaluate treatment patterns and outcomes for patients ≥80 years old with advanced NSCLC.
We identified patients diagnosed with metastatic NSCLC between 2004 and 2014. We divided them into two groups: < 80 years old (n = 218,365) and ≥ 80 years old (n = 33,352). Patient characteristics including median age at diagnosis, gender, ethnicity, histology, chemotherapy status, tumor grade, treatment center, insurance status, income, education, and Charlson-Deyo co-morbidity index were collected. Continuous variables were compared using t-test and categorical variables were compared using chi-square or Fisher's exact test. Multivariable (MV) and propensity matched analyses were performed to analyze the impact of chemotherapy on overall survival.
We identified 33,352 patients > 80 years old diagnosed with advanced NSCLC. Only 29 % received chemotherapy, those who received chemotherapy had improved median overall survival of 8 months compared to 2 months in patients not receiving chemotherapy; adjusted hazards ratio (HR) 0.46; confidence interval (CI) 0.45-0.47; p < .001. MV analysis showed benefit of chemotherapy in all age subgroups (80-84 years, 85-89 years and 90+ years; p < .0001) and it was confirmed by propensity matched analysis. Patients receiving multiagent chemotherapy had improved 1-year survival of 35.5 % compared to 32.8 % with single agent chemotherapy (adjusted HR 0.92; CI 0.88-0.96; p < .001). Despite benefit from chemotherapy, the proportion of patients age ≥ 80 years receiving chemotherapy did not change over time.
Chemotherapy improved overall survival in ≥80 years old patients with advanced stage NSCLC. Despite improved survival and an increase in the proportion of ≥80 years old patients diagnosed with advanced NSCLC, less than one-third receive chemotherapy.
对于 80 岁以上患有晚期非小细胞肺癌（NSCLC）的患者，化疗的作用数据有限。我们使用国家癌症数据库（NCDB）评估了≥80 岁患有晚期 NSCLC 的患者的治疗模式和结局。
我们鉴定了 2004 年至 2014 年期间诊断为转移性 NSCLC 的患者。将他们分为两组：<80 岁（n=218365）和≥80 岁（n=33352）。收集了患者特征，包括诊断时的中位年龄、性别、种族、组织学、化疗状况、肿瘤分级、治疗中心、保险状况、收入、教育程度和 Charlson-Deyo 合并症指数。使用 t 检验比较连续变量，使用卡方检验或 Fisher 精确检验比较分类变量。进行多变量（MV）和倾向匹配分析，以分析化疗对总生存的影响。
我们鉴定了 33352 例≥80 岁诊断为晚期 NSCLC 的患者。仅有 29%接受了化疗，接受化疗的患者中位总生存时间为 8 个月，而未接受化疗的患者中位总生存时间为 2 个月；调整后的风险比（HR）为 0.46；95%置信区间（CI）为 0.45-0.47；p<0.001。MV 分析显示，在所有年龄亚组（80-84 岁、85-89 岁和 90 岁以上；p<0.0001）中，化疗均有益，且经倾向匹配分析证实。接受联合化疗的患者 1 年生存率为 35.5%，而接受单药化疗的患者 1 年生存率为 32.8%（调整 HR 0.92；95%CI 0.88-0.96；p<0.001）。尽管化疗有益，但≥80 岁患者接受化疗的比例并未随时间变化。
化疗改善了≥80 岁患有晚期 NSCLC 患者的总生存。尽管生存率提高，且≥80 岁被诊断为晚期 NSCLC 的患者比例增加，但接受化疗的患者不足三分之一。
