Department of Radiation Oncology, Beaumont Health, Royal Oak, MI United States.
Department of Radiation Oncology, Beaumont Health, Royal Oak, MI United States.
Cancer Treat Res Commun. 2022;32:100571. doi: 10.1016/j.ctarc.2022.100571. Epub 2022 May 2.
Debate exists regarding the optimal management for patients with stage III non-small-cell lung cancer (NSCLC). Recent inclusion of chemotherapeutic data in the Surveillance, Epidemiology, and End Results (SEER) database has made it possible to identify patients with NSCLC who received chemotherapy. We hypothesized that patients with stage III NSCLC experience improved overall survival from trimodality therapy (TMT) versus definitive chemoradiation therapy (CRT) alone.
We analyzed the overall survival of stage III NSCLC patients based on the receipt of TMT versus CRT alone. This included crude and adjusted univariate models as well as crude and doubly robust adjusted multivariable analyses, both utilizing propensity score matching and inverse probability of treatment weighting. Factors included in the multivariable analyses included: age, sex, marital status, income, date of diagnosis, primary site, histology, grade, T stage, N stage, and intended treatment. Planned subset analyses were performed for stage III(N2) patients.
Adult patients with stage III NSCLC (N = 9008) from the SEER database were included in our analyses. In our univariate analyses, an overall survival benefit was observed for TMT versus CRT (CrudeHR = 0.58, 95% CI = 0.55-0.61, p < 0.001; AdjHR = 0.58, 95% CI = 0.54-0.61, p < 0.001). This persisted in both crude and doubly robust multivariable analyses (CrudeHR = 0.57, 95% CI = 0.53-0.61, p < 0.001; AdjHR = 0.56, 95% CI = 0.53-0.59, p < 0.001). Patients with stage III(N2) disease also demonstrated a significant benefit to OS with TMT versus CRT alone.
The significant difference in overall survival seen with TMT suggests this may be an effective treatment approach for select patients.
关于 III 期非小细胞肺癌（NSCLC）患者的最佳治疗方法存在争议。最近，化疗数据被纳入监测、流行病学和最终结果（SEER）数据库，这使得识别接受化疗的 NSCLC 患者成为可能。我们假设与单纯根治性放化疗（CRT）相比，III 期 NSCLC 患者接受三联疗法（TMT）可获得更好的总生存期。
我们根据 TMT 与 CRT 治疗的情况，分析了 III 期 NSCLC 患者的总生存期。这包括了基于粗率和调整后的单变量模型，以及基于倾向评分匹配和逆概率处理权重的粗率和双重稳健调整的多变量分析。多变量分析中包括的因素包括：年龄、性别、婚姻状况、收入、诊断日期、原发部位、组织学、分级、T 分期、N 分期和治疗意图。对 III（N2）期患者进行了计划的亚组分析。
我们的分析纳入了 SEER 数据库中 III 期 NSCLC（N=9008）的成年患者。在单变量分析中，与 CRT 相比，TMT 观察到总生存期的获益（粗率 HR=0.58，95%CI=0.55-0.61，p<0.001；调整后 HR=0.58，95%CI=0.54-0.61，p<0.001）。这在粗率和双重稳健调整的多变量分析中均得到了维持（粗率 HR=0.57，95%CI=0.53-0.61，p<0.001；调整后 HR=0.56，95%CI=0.53-0.59，p<0.001）。III（N2）期疾病患者也表现出 TMT 与单纯 CRT 相比 OS 显著获益。
TMT 观察到的总生存期显著差异表明，对于某些患者来说，这可能是一种有效的治疗方法。
