Evers Jelle, de Jaeger Katrien, Hendriks Lizza E L, van der Sangen Maurice, Terhaard Chris, Siesling Sabine, De Ruysscher Dirk, Struikmans Henk, Aarts Mieke J
Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands; University of Twente, Department of Health Technology and Services Research, Hallenweg 5, 7522 NH Enschede, the Netherlands.
Catharina Hospital, Department of Radiation Oncology, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands.
Lung Cancer. 2021 May;155:103-113. doi: 10.1016/j.lungcan.2021.03.013. Epub 2021 Mar 20.
This Dutch population-based study describes nationwide treatment patterns and its variations for stage I-III non-small cell lung cancer (NSCLC).
Patients diagnosed with clinical stage I-III NSCLC in the period 2008-2018 were selected from the Netherlands Cancer Registry. Treatment trends were studied over time and age groups. Use of radiotherapy versus surgery (stage I-II), and concurrent versus sequential chemoradiotherapy (stage III) were analyzed by logistic regression.
In stage I, the rate of surgery decreased from 58 % (2008) to 40 % (2018) while radiotherapy use increased over time (from 31 % to 52 %), which mostly concerned stereotactic body radiotherapy (74 %). In stage II, 54 % of patients received surgery, and use of radiotherapy alone increased from 18 % to 25 %. The strongest factors favoring radiotherapy over surgery were WHO performance status (OR ≥ 2 vs 0: 23.39 (95% CI: 18.93-28.90)), increasing age (OR ≥ 80 vs <60 years: 14.52 (95% CI: 13.02-16.18)) and stage (OR stage II vs I: 0.61 (95% CI: 0.57-0.65)). In stage III, the combined use of chemotherapy and radiotherapy increased from 35 % (2008) to 39 % (2018). In all years, 23 % received concurrent chemoradiotherapy, 9 % sequential chemoradiotherapy, 23 % radiotherapy or chemotherapy alone, and 25 % best supportive care. The strongest factors favoring concurrent over sequential chemoradiotherapy were age (OR ≥ 80 vs <60 years: 0.14 (95% CI: 0.10-0.19)), WHO Performance status (OR ≥ 2 vs 0: 0.33 (95% CI: 0.24-0.47)) and region (OR east vs north: 0.39 (95% CI: 0.30-0.50)).
The use of radiotherapy became more prominent over time in stage I NSCLC. Combined use of chemotherapy and radiotherapy marginally increased in stage III: only one third of patients received chemoradiotherapy, mainly concurrently. Treatment variation seen between patient groups suggests tailored treatment decision, while variation between hospitals and regions indicate differences in clinical practice.
这项基于荷兰人群的研究描述了I - III期非小细胞肺癌（NSCLC）的全国治疗模式及其变化情况。
从荷兰癌症登记处选取2008 - 2018年期间诊断为临床I - III期NSCLC的患者。研究治疗趋势随时间和年龄组的变化。通过逻辑回归分析I - II期放疗与手术的使用情况，以及III期同步与序贯放化疗的使用情况。
在I期，手术率从2008年的58%降至2018年的40%，而放疗的使用随时间增加（从31%增至52%），其中大部分为立体定向体部放疗（74%）。在II期，54%的患者接受了手术，单纯放疗的使用从18%增至25%。相较于手术，最有利于放疗的因素是世界卫生组织（WHO）体能状态（OR≥2 vs 0：23.39（95% CI：18.93 - 28.90））、年龄增加（OR≥80岁vs <60岁：14.52（95% CI：13.02 - 16.18））和分期（OR II期vs I期：0.61（95% CI：0.57 - 0.65））。在III期，化疗与放疗的联合使用从2008年的35%增至2018年的39%。在所有年份中，23%的患者接受同步放化疗，9%接受序贯放化疗，23%接受单纯放疗或化疗，25%接受最佳支持治疗。相较于序贯放化疗，最有利于同步放化疗的因素是年龄（OR≥80岁vs <60岁：0.14（95% CI：0.10 - 0.19））、WHO体能状态（OR≥2 vs 0：0.33（95% CI：0.24 - 0.47））和地区（OR东部vs北部：0.39（95% CI：0.30 - 0.50））。
随着时间推移，放疗在I期NSCLC中的使用变得更加突出。III期化疗与放疗的联合使用略有增加：只有三分之一的患者接受放化疗，主要是同步放化疗。患者组之间的治疗差异表明需要量身定制治疗决策，而医院和地区之间的差异表明临床实践存在不同。
