Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA.
Institute for Translational Epidemiology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Eur J Cardiothorac Surg. 2023 Aug 1;64(2). doi: 10.1093/ejcts/ezad203.
Non-small-cell lung cancer mortality has declined at a faster rate than incidence due to multiple factors, including changes in smoking behaviour, early detection which shifts diagnosis, and novel therapies. Limited resources require that we quantify the contribution of early detection versus novel therapies in improving lung cancer survival outcomes.
Non-small-cell lung cancer patients from the Surveillance, Epidemiology, and End Results-Medicare data were queried and divided into: (i) stage IV diagnosed in 2015 (n = 3774) and (ii) stage I-III diagnosed in 2010-2012 (n = 15 817). Multivariable Cox-proportional hazards models were performed to assess the independent association of immunotherapy or diagnosis at stage I/II versus III with survival.
Patients treated with immunotherapy had significantly better survival than those who did not (HRadj: 0.49, 95% confidence interval: 0.43-0.56), as did those diagnosed at stage I/II versus stage III (HRadj: 0.36, 95% confidence interval: 0.35-0.37). Patients on immunotherapy had a 10.7-month longer survival than those who were not. Stage I/II patients had an average survival benefit of 34 months, compared to stage III. If 25%% of stage IV patients not on immunotherapy received it, there would be a gain of 22 292 person-years survival per 100 000 diagnoses. A switch of only 25% from stage III to stage I/II would correspond to 70 833 person-years survival per 100 000 diagnoses.
In this cohort study, earlier stage at diagnosis contributed to life expectancy by almost 3 years, while gains from immunotherapy would contribute ½ year of survival. Given the relative affordability of early detection, risk reduction through increased screening should be optimized.
由于多种因素的影响，非小细胞肺癌的死亡率下降速度快于发病率，这些因素包括吸烟行为的改变、诊断时的早期检测以及新疗法的出现。由于资源有限，我们需要量化早期检测和新疗法在改善肺癌生存结果方面的贡献。
从监测、流行病学和最终结果-医疗保险数据中查询非小细胞肺癌患者，并将其分为：（i）2015 年诊断为 IV 期（n=3774）和（ii）2010-2012 年诊断为 I-III 期（n=15817）。采用多变量 Cox 比例风险模型评估免疫治疗或 I/II 期与 III 期诊断与生存的独立关联。
与未接受免疫治疗的患者相比，接受免疫治疗的患者的生存时间明显更长（HRadj：0.49，95%置信区间：0.43-0.56），I/II 期与 III 期诊断的患者也是如此（HRadj：0.36，95%置信区间：0.35-0.37）。接受免疫治疗的患者比未接受免疫治疗的患者多生存 10.7 个月。与 III 期相比，I/II 期患者的平均生存获益为 34 个月。如果将 25%未接受免疫治疗的 IV 期患者转为接受免疫治疗，那么每 10 万人诊断中就会有 22292 人/年的生存获益。如果仅将 25%的 III 期患者转为 I/II 期，那么每 10 万人诊断中就会有 70833 人/年的生存获益。
在这项队列研究中，诊断时更早的分期使预期寿命延长了近 3 年，而免疫治疗的获益则使生存时间延长了半年。鉴于早期检测的相对可负担性，应通过增加筛查来优化风险降低。
