Lester-Coll Nataniel H, Skelly Joan, Vacek Pamela M, Sprague Brian L
Division of Radiation Oncology, University of Vermont Larner College of Medicine, Burlington, VT, USA.
University of Vermont Cancer Center, Burlington, VT, USA.
J Thorac Dis. 2022 Jul;14(7):2579-2590. doi: 10.21037/jtd-21-1835.
The purpose of this study is to describe stereotactic body radiation therapy (SBRT) use, outcomes, hospitalizations and costs compared to patients receiving chemotherapy among patients with metastatic non-small cell lung cancer (NSCLC).
Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we identified patients aged ≥66 with metastatic NSCLC treated with SBRT as first-line treatment between 2004 and 2014. Multivariable logistic regression identified covariates associated with SBRT. Overall survival (OS) between SBRT and chemotherapy was compared using the Kaplan-Meier estimator and Cox proportional hazards regression. To compare hospitalizations and associated costs, we matched patients treated with SBRT to those with comparable prognostic factors receiving chemotherapy.
We identified 215 patients with metastatic NSCLC who received SBRT and 12,486 patients who received chemotherapy as first-line treatment. SBRT use increased from 0.5% to 3% and was associated with older age, female sex, poor disability status, and lower T- and N-stage. OS increased with SBRT, female sex, higher income and decreased with higher Charlson Comorbidity Score ≥2, poor disability status, higher T-stage and higher N-stage. Among a matched sample, SBRT patients underwent fewer hospitalizations chemotherapy patients (73% 81%, P=0.02). Among those hospitalized, SBRT patients incurred higher hospitalization costs ($33,063 $23,865, P<0.001) but costs per month of survival were similar.
SBRT is increasing among Medicare patients with metastatic NSCLC. Our findings suggest that SBRT may play a role in management of select metastatic NSCLC patients in addition to standard-of-care chemotherapy.
本研究的目的是描述立体定向体部放射治疗（SBRT）在转移性非小细胞肺癌（NSCLC）患者中的使用情况、疗效、住院情况及成本，并与接受化疗的患者进行比较。
利用监测、流行病学和最终结果（SEER）-医疗保险数据库，我们确定了2004年至2014年间年龄≥66岁、接受SBRT作为一线治疗的转移性NSCLC患者。多变量逻辑回归确定了与SBRT相关的协变量。使用Kaplan-Meier估计器和Cox比例风险回归比较SBRT和化疗之间的总生存期（OS）。为了比较住院情况及相关成本，我们将接受SBRT治疗的患者与具有可比预后因素的接受化疗的患者进行匹配。
我们确定了215例接受SBRT的转移性NSCLC患者和12486例接受化疗作为一线治疗的患者。SBRT的使用从0.5%增加到3%，且与年龄较大、女性、残疾状态较差以及较低的T和N分期相关。OS随着SBRT、女性、较高收入而增加，随着Charlson合并症评分≥2、残疾状态较差、较高的T分期和较高的N分期而降低。在匹配样本中，SBRT患者的住院次数少于化疗患者（73%对81%，P = 0.02）。在住院患者中，SBRT患者的住院成本更高（33063美元对23865美元），P<0.001），但每月生存成本相似。
SBRT在医疗保险的转移性NSCLC患者中的使用正在增加。我们的研究结果表明，除了标准治疗化疗外，SBRT可能在特定转移性NSCLC患者的管理中发挥作用。
