Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030.
Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030.
Cancer Res Commun. 2022 Jul;2(7):590-601. doi: 10.1158/2767-9764.crc-22-0179. Epub 2022 Jul 6.
Inflammation is a cancer hallmark. Nonsteroidal anti-inflammatory drugs (NSAIDs) improve overall survival (OS) in certain cancers. Real-world studies explored here if NSAIDs improve non-small cell lung cancer (NSCLC) OS. Analyses independently interrogated clinical databases from The University of Texas MD Anderson Cancer Center (MDACC cohort, 1987 to 2015; 33,162 NSCLCs and 3,033 NSAID users) and Georgetown-MedStar health system (Georgetown cohort, 2000 to 2019; 4,497 NSCLCs and 1,993 NSAID users). Structured and unstructured clinical data were extracted from electronic health records (EHRs) using natural language processing (NLP). Associations were made between NSAID use and NSCLC prognostic features (tobacco use, gender, race, and body mass index, BMI). NSAIDs were statistically-significantly (P < 0.0001) associated with increased NSCLC survival (5-year OS 29.7% for NSAID users versus 13.1% for non-users) in the MDACC cohort. NSAID users gained 11.6 months over nonusers in 5-year restricted mean survival time. Stratified analysis by stage, histopathology and multicovariable assessment substantiated benefits. NSAID users were pooled independent of NSAID type and by NSAID type. Landmark analysis excluded immortal time bias. Survival improvements (P < 0.0001) were confirmed in the Georgetown cohort. Thus, real-world NSAID usage was independently associated with increased NSCLC survival in the MDACC and Georgetown cohorts. Findings were confirmed by landmark analyses and NSAID type. The OS benefits persisted despite tobacco use and did not depend on gender, race, or BMI (MDACC cohort, P < 0.0001). These real-world findings could guide future NSAID lung cancer randomized trials.
炎症是癌症的一个标志。非甾体抗炎药（NSAIDs）可改善某些癌症的总生存期（OS）。本研究通过真实世界研究探索了 NSAIDs 是否能改善非小细胞肺癌（NSCLC）的 OS。分析分别独立地对德克萨斯大学 MD 安德森癌症中心（MDACC 队列，1987 年至 2015 年；33162 例 NSCLC 和 3033 例 NSAID 使用者）和乔治城梅多斯健康系统（乔治城队列，2000 年至 2019 年；4497 例 NSCLC 和 1993 例 NSAID 使用者）的临床数据库进行了研究。使用自然语言处理（NLP）从电子健康记录（EHR）中提取了结构化和非结构化的临床数据。研究了 NSAID 使用与 NSCLC 预后特征（吸烟、性别、种族和体重指数，BMI）之间的关系。在 MDACC 队列中，NSAIDs 与 NSCLC 生存的统计学显著相关（P < 0.0001）（NSAID 使用者的 5 年 OS 为 29.7%，而非使用者为 13.1%）。在 5 年受限平均生存时间方面，NSAID 使用者比非使用者多生存 11.6 个月。分层分析按阶段、组织病理学和多变量评估证实了获益。NSAID 使用者被汇集，无论 NSAID 类型如何，以及按 NSAID 类型进行汇集。里程碑分析排除了不朽时间偏倚。在乔治城队列中也证实了生存改善（P < 0.0001）。因此，真实世界中 NSAID 的使用与 MDACC 和乔治城队列中 NSCLC 生存的增加独立相关。通过里程碑分析和 NSAID 类型证实了这一发现。OS 获益在 MDACC 队列中仍然存在，尽管有吸烟，但与性别、种族或 BMI 无关（P < 0.0001）。这些真实世界的发现可以为未来的 NSAID 肺癌随机试验提供指导。
