Burns Ethan A, Chen Wan Hsiang, Mathur Sunil, Kieser Ryan B, Zhang Jun, Bernicker Eric H
Neal Cancer Center, Houston Methodist Hospital, Houston, Texas.
Department of Academic Medicine, Houston Methodist Hospital, Houston, Texas.
JTO Clin Res Rep. 2023 Sep 9;4(10):100570. doi: 10.1016/j.jtocrr.2023.100570. eCollection 2023 Oct.
The aim of this study is to evaluate treatment patterns, survival outcomes, and factors influencing systemic treatment decisions in adults 80 years and older with NSCLC.
This was a retrospective National Cancer Database study evaluating outcomes in adults aged 80 years and older with advanced NSCLC. Patients were analyzed on the basis of systemic therapy, including none, chemotherapy or immunotherapy (IO) alone, and chemotherapy plus IO (chemotherapy + IO). Median overall survival (OS) was compared using Kaplan-Meier methodology. Hazard ratio with 95% confidence interval (CI) was used to assess differences in outcomes, and OR with 95% CI was used to assess factors contributing to systemic therapy provision.
Patients 80 years and older (OR = 1.135 [95% CI: 1.127-1.142], = 0.000), females (OR = 1.129 [95% CI: 1.085-1.175], < 0.001), blacks (OR = 1.272 [95% CI: 1.179-1.372], < 0.001), non-Hispanic whites (OR = 1.210 [95% CI: 1.075-1.362], = 0.002), and those with increasing Charlson-Deyo Comorbidity Index score ( < 0.001) were less likely to receive systemic therapy. Median OS for no therapy, IO alone, chemotherapy alone, and chemotherapy plus IO was 2.63 (95% CI: 2.57-2.69), 10.68 (95% CI: 9.96-11.39), 12.35 (95% CI: 11.98-12.72), and 14.03 (95% CI: 13.87-14.88) months, respectively. In chemotherapy alone, mean OS was 1.12 months (95% CI: 0.55-1.70) ( < 0.001) longer with multiagent versus single agent. There was no difference between IO plus single agent versus IO plus multiagent chemotherapy (0.67 mo [95% CI -1.18 to 2.54], = 1.00).
Age, comorbidities, patient race, and sex affected systemic therapy provision. Multiagent chemotherapy and chemotherapy plus IO significantly improved survival; with the latter, survival was similar with IO plus single or multiagent chemotherapy.
本研究旨在评估80岁及以上非小细胞肺癌（NSCLC）成人患者的治疗模式、生存结果以及影响全身治疗决策的因素。
这是一项回顾性国家癌症数据库研究，评估80岁及以上晚期NSCLC成人患者的治疗结果。根据全身治疗情况对患者进行分析，包括未接受治疗、单纯化疗或免疫治疗（IO）以及化疗联合IO（化疗 + IO）。采用Kaplan-Meier方法比较中位总生存期（OS）。使用95%置信区间（CI）的风险比评估结果差异，使用95%CI的优势比评估促成全身治疗的因素。
80岁及以上患者（优势比 = 1.135 [95%CI：1.127 - 1.142]，P = 0.000）、女性（优势比 = 1.129 [95%CI：1.085 - 1.175]，P < 0.001）、黑人（优势比 = 1.272 [95%CI：1.179 - 1.372]，P < 0.001）、非西班牙裔白人（优势比 = 1.210 [95%CI：1.075 - 1.362]，P = 0.002）以及Charlson-Deyo合并症指数评分增加的患者（P < 0.001）接受全身治疗的可能性较小。未治疗、单纯IO、单纯化疗以及化疗联合IO的中位OS分别为2.63（95%CI：2.57 - 2.69）、10.68（95%CI：9.96 - 11.39）、12.35（95%CI：11.98 - 12.72）和14.03（95%CI：13.87 - 14.88）个月。在单纯化疗中，多药联合治疗的平均OS比单药治疗长1.12个月（95%CI：0.55 - 1.70）（P < 0.001）。IO联合单药化疗与IO联合多药化疗之间无差异（0.67个月 [95%CI -1.18至2.54]，P = 1.00）。
年龄、合并症、患者种族和性别影响全身治疗的提供。多药联合化疗和化疗联合IO显著改善了生存；对于后者，IO联合单药或多药化疗的生存情况相似。
