评估 COVID-19 期间非小细胞肺癌的治疗策略:倾向评分匹配分析。

Evaluating treatment strategies for non-small cell lung cancer during COVID-19: A propensity score matching analysis.

机构信息

Department of Thoracic Surgery, Chengdu BOE Hospital, Chengdu, China.

Department of Clinical Laboratory, The Third People's Hospital of Mianyang·Sichuan Mental Health Center, Mianyang, China.

出版信息

Medicine (Baltimore). 2022 Aug 12;101(32):e30051. doi: 10.1097/MD.0000000000030051.

Abstract

We employed pandemic treatment strategies that we developed at the beginning of the coronavirus disease 2019 (COVID-19) pandemic, and it was not clear whether any adverse results were associated with our strategies. Therefore, we carried out a retrospective study to compare our pandemic treatment strategies with prepandemic protocols to determine whether the strategies used during the high-risk period of COVID-19 were appropriate. The observation period was September 2019 to February 2020. Patients hospitalized from December 2019 to February 2020 were included as an experimental group, and individuals hospitalized from September 2019 to November 2019 were included as a control group. All non-small cell lung cancer patients hospitalized during the observation period were included except for pediatric and obstetric patients, patients younger than 18 years old, and patients admitted only for routine follow-up examinations. Treatment strategies were evaluated based on the prognosis of the different treatment methods, including surgical and nonsurgical treatments and discontinuation of therapy. Survival curves were analyzed using the Kaplan-Meier method. Cox regression analysis was used for multivariate analysis of risk factors for progress-free survival. Propensity score matching was used for clinical characteristics to adjust for selection bias. Therapy discontinuation in the experimental group was significantly higher than in the control group (P < .001). The differences in cancer progression and the number of deaths between the 2 groups were not significant (P = .38 and .13, respectively). For late-stage patients, there were significant differences in nonsurgical treatment and discontinued therapy (P < .001 and < .001, respectively) between the 2 groups, while the cancer progression and death toll differences were not significant (P = .20 and .20, respectively). For early-stage patients, the differences in surgical treatment, discontinued therapy, cancer progression, and death toll were not significant (P = .24, 0.24, 0.61, and 0.49, respectively) between the 2 groups. Multivariate analysis revealed that temporary discontinuation of therapy did not predict poor progress-free survival independently (hazard ratio = 1.007, 95% confidence interval: 0.653-1.552, P = .98). For patients in geographical regions with a high risk for COVID-19 infections, temporarily suspending treatment for late-stage non-small cell lung cancer patients is not likely to significantly impact their prognosis if they can return to treatment within 3 months of discontinuation.

摘要

我们采用了在 2019 年冠状病毒病(COVID-19)大流行初期开发的大流行治疗策略,但尚不清楚任何不良结果是否与我们的策略有关。因此,我们进行了一项回顾性研究,将我们的大流行治疗策略与大流行前方案进行比较,以确定在 COVID-19 的高风险期间使用的策略是否合适。观察期为 2019 年 9 月至 2020 年 2 月。将 2019 年 12 月至 2020 年 2 月住院的患者纳入实验组,将 2019 年 9 月至 11 月住院的患者纳入对照组。除儿科和产科患者、18 岁以下患者以及仅进行常规随访检查的患者外,观察期间所有住院的非小细胞肺癌患者均被纳入研究。基于不同治疗方法的预后评估治疗策略,包括手术和非手术治疗以及停止治疗。采用 Kaplan-Meier 法分析生存曲线。采用 Cox 回归分析进行无进展生存的多因素分析。采用倾向评分匹配法对临床特征进行调整,以消除选择偏倚。实验组的治疗中断率明显高于对照组(P <.001)。两组之间癌症进展和死亡人数无显著差异(P =.38 和.13)。对于晚期患者,两组之间非手术治疗和停止治疗的差异有统计学意义(P <.001 和 <.001),而癌症进展和死亡人数无显著差异(P =.20 和.20)。对于早期患者,两组之间手术治疗、停止治疗、癌症进展和死亡人数的差异均无统计学意义(P =.24、0.24、0.61 和 0.49)。多因素分析显示,暂时停止治疗并不能独立预测无进展生存不良(风险比=1.007,95%置信区间:0.653-1.552,P =.98)。对于 COVID-19 感染高风险地区的患者,如果晚期非小细胞肺癌患者在停止治疗后 3 个月内能够恢复治疗,则暂时停止治疗不太可能对其预后产生重大影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e7f3/9371518/09b0e41a9864/medi-101-e30051-g001.jpg

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