Kiss Zoltán, Gálffy Gabriella, Müller Veronika, Moldvay Judit, Sárosi Veronika, Pápai-Székely Zsolt, Csada Edit, Kerpel-Fronius Anna, Király Zsolt, Szász Zoltán, Hódi Gábor, Polányi Zoltán, Kovács Krisztina, Karamousouli Eugenia, Knollmajer Kata, Szabó Tamás G, Berta Andrea, Vokó Zoltán, Rokszin György, Abonyi-Tóth Zsolt, Barcza Zsófia, Tamási Lilla, Bogos Krisztina
MSD Pharma Hungary Ltd, Budapest, Hungary.
Second Department of Medicine and Nephrology-Diabetes Center, University of Pécs Medical School, Pécs, Hungary.
Front Oncol. 2023 Oct 4;13:1207295. doi: 10.3389/fonc.2023.1207295. eCollection 2023.
The approval of immunotherapy (I-O) for the treatment of late-stage non-small cell lung cancer (NSCLC) opened new perspectives in improving survival outcomes. However, survival data have not yet been provided from the period of the Covid-19 pandemic. The aims of our study were to assess and compare survival outcomes of patients with advanced LC receiving systemic anticancer treatment (SACT) before and after the approval of immunotherapy in Hungary, and to examine the impact of pandemic on survival outcomes using data from the Hungarian National Health Insurance Fund (NHIF) database.
This retrospective, longitudinal study included patients aged ≥20 years who were diagnosed with advanced stage lung cancer (LC) (ICD-10 C34) between 1 January 2011 and 31 December 2021 and received SACT treatment without LC-related surgery. Survival rates were evaluated by year of diagnosis, sex, age, and LC histology.
In total, 35,416 patients were newly diagnosed with advanced LC and received SACT during the study period (mean age at diagnosis: 62.1-66.3 years). In patients with non-squamous cell carcinoma, 3-year survival was significantly higher among those diagnosed in 2019 vs. 2011-2012 (28.7% [95% CI: 26.4%-30.9%] vs. 14.45% [95% CI: 13.21%-15.69%], respectively). In patients with squamous cell carcinoma, 3-year survival rates were 22.3% (95% CI: 19.4%-25.2%) and 13.37% (95% CI: 11.8%-15.0%) in 2019 and 2011-2012, respectively, the change was statistically significant. Compared to 2011-2012, the hazard ratio of survival change for non-squamous cell carcinoma patients was 0.91, 0.82, and 0.62 in 2015-2016, 2017-2018, and 2019, respectively (p<0.001 for all cases). In the squamous cell carcinoma group, corresponding hazard ratios were 0.93, 0.87, and 0.78, respectively (p<0.001 for all cases). Survival improvements remained significant in both patient populations during the Covid-19 pandemic (2020-2021). No significant improvements were found in the survival of patients with small cell carcinoma. Platinum-based chemotherapy was the most common first-line treatment in all diagnostic periods, however, the proportion of patients receiving first- or second-line immunotherapy significantly increased during the study period.
3-year survival rates of NSCLC almost doubled among patients with non-squamous cell carcinoma and significantly improved at squamous cell carcinoma over the past decade in Hungary. Improvements could potentially be attributable by the introduction of immunotherapy and were not offset by the Covid-19 pandemic.
免疫疗法（I-O）获批用于治疗晚期非小细胞肺癌（NSCLC）为改善生存结局开辟了新前景。然而，新冠疫情期间的生存数据尚未提供。我们研究的目的是评估和比较匈牙利免疫疗法获批前后接受全身抗癌治疗（SACT）的晚期肺癌（LC）患者的生存结局，并利用匈牙利国家健康保险基金（NHIF）数据库的数据研究疫情对生存结局的影响。
这项回顾性纵向研究纳入了年龄≥20岁、在2011年1月1日至2021年12月31日期间被诊断为晚期肺癌（ICD-10 C34）且接受了无LC相关手术的SACT治疗的患者。通过诊断年份、性别、年龄和LC组织学评估生存率。
在研究期间，共有35416例患者新诊断为晚期LC并接受了SACT治疗（诊断时的平均年龄：62.1 - 66.3岁）。在非鳞状细胞癌患者中，2019年诊断的患者3年生存率显著高于2011 - 2012年诊断的患者（分别为28.7% [95% CI：26.4% - 30.9%] 与14.45% [95% CI：13.21% - 15.69%]）。在鳞状细胞癌患者中，2019年和2011 - 2012年的3年生存率分别为22.3%（95% CI：19.4% - 25.2%）和13.37%（95% CI：11.8% - 15.0%），变化具有统计学意义。与2011 - 2012年相比，2015 - 2016年、2017 - 2018年和2019年非鳞状细胞癌患者生存变化的风险比分别为0.91、0.82和0.62（所有病例p<0.001）。在鳞状细胞癌组中，相应的风险比分别为0.93、0.87和0.78（所有病例p<0.001）。在新冠疫情期间（2020 - 2021年），这两类患者群体的生存改善均保持显著。小细胞癌患者的生存率未发现显著改善。铂类化疗是所有诊断时期最常见的一线治疗方法，然而，在研究期间接受一线或二线免疫疗法的患者比例显著增加。
在匈牙利，过去十年间非鳞状细胞癌患者的NSCLC 3年生存率几乎翻倍，鳞状细胞癌患者的生存率也显著提高。这些改善可能归因于免疫疗法的引入，且未被新冠疫情所抵消。
