Formerly of the Centre of Biostatistics, University of Limerick, Limerick, Ireland.
Ir J Med Sci. 2024 Apr;193(2):927-936. doi: 10.1007/s11845-023-03465-9. Epub 2023 Aug 22.
Lung cancer is a major cause of death in Western countries, but survival had never been studied in Northern Ireland (NI) on a population basis prior to this study.
The primary aims were to describe the survival of patients with primary lung cancer, evaluate the effect of treatment, identify patient characteristics influencing survival and treatment and describe current trends in survival.
A population-based study identified all incident cases of primary lung cancer in NI during 1991-2 and followed them for 21 months. Their clinical notes were traced and relevant details abstracted. Survival status was monitored via the Registrar General's Office, and ascertainment is thought to be near-complete. Appropriate statistical methods were used to analyse the survival data.
Some 855 incident cases were studied. Their 1-year survival was 24.5% with a median survival time of 4.7 months. Surgical patients had the best 1-year survival, 76.8%; however, adjustment suggested that about half of the benefit could be attributed to case-mix factors. Factors influencing treatment allocation were also identified, and a screening test showed the discordance between 'model' and 'medic': 210 patients were misclassified. Finally, the current trend in 1-year survival observed in the Republic of Ireland was best in the British Isles.
Overall, survival remains poor. The better survival of surgical patients is due, in part, to their superior case-mix profiles. Survival with other therapies is less good suggesting that the criteria for treatment might be relaxed with advantage using a treatment model to aid decision-making.
肺癌是西方国家主要的死亡原因，但在此项研究之前，北爱尔兰（NI）从未基于人群对其进行过生存研究。
主要目的是描述原发性肺癌患者的生存情况，评估治疗效果，确定影响生存和治疗的患者特征，并描述目前的生存趋势。
本项基于人群的研究确定了 1991-2 年间 NI 中所有原发性肺癌的发病病例，并对其随访了 21 个月。追踪了他们的临床记录并提取了相关细节。通过注册总署监测生存状态，认为其登记几乎是完整的。采用适当的统计方法对生存数据进行了分析。
研究了 855 例发病病例。他们的 1 年生存率为 24.5%，中位生存时间为 4.7 个月。手术患者的 1 年生存率最高，为 76.8%；然而，调整后表明，约一半的获益可归因于病例组合因素。还确定了影响治疗分配的因素，一项筛选试验显示了“模型”和“药物”之间的差异：210 名患者被误诊。最后，爱尔兰共和国目前观察到的 1 年生存率趋势在不列颠群岛中最好。
总体而言，生存仍然较差。手术患者的更好生存部分归因于其优越的病例组合特征。其他治疗方法的生存效果较差，这表明使用治疗模型辅助决策可能会放宽治疗标准，从而获得优势。
