Rodriguez-Quintero Jorge Humberto, Kamel Mohamed K, Jindani Rajika, Zhu Roger, Loh Isaac, Vimolratana Marc, Chudgar Neel P, Stiles Brendon
Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
Department of Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, NY, USA.
Eur J Cardiothorac Surg. 2024 Dec 26;67(1). doi: 10.1093/ejcts/ezae450.
Although surgery is considered the standard of care for early-stage lung cancer, there has been increased use of stereotactic radiotherapy for operable patients in recent years. Given that this modality may be perceived as a more practical treatment, we hypothesized that it might be more often delivered to patients who experience barriers to care.
The National Cancer Database (2018-2020) was queried for patients with clinical stage IA non-small cell lung cancer treated with surgery or stereotactic radiotherapy (48-60 Gy, 3-5 fractions), excluding patients with contraindications to surgery. Patients who had all the following characteristics were categorized as experiencing 'high barriers' to treatment: income below median national levels, lack of private insurance, treatment at a community facility and residence in non-metropolitan areas. Using multivariable logistic regression, the association between high barriers to treatment and stereotactic radiotherapy use was estimated.
A total of 60 829 patients were included, of whom 3382 (5.6%) experienced high barriers to treatment. Among them, 13 535 (22.3%) underwent stereotactic radiotherapy and 47 294 (77.7%) underwent surgery. Overall, more patients undergoing stereotactic radiotherapy faced high barriers to treatment compared to those who received surgery (8.6% vs 4.7%, P < 0.001). Geographic region was associated with the delivery of stereotactic radiotherapy (P < 0.001). The magnitude of such association was stronger among those who faced high barriers. In multivariable analysis, experiencing high barriers to treatment remained associated with receiving stereotactic radiotherapy (OR: 1.46, 95% CI 1.35-1.58).
The use of stereotactic radiotherapy is more prevalent among patients facing barriers to care. Further research is needed to clarify the role of this treatment modality in early-stage lung cancer.
尽管手术被认为是早期肺癌的标准治疗方法，但近年来，立体定向放射治疗在可手术患者中的应用有所增加。鉴于这种治疗方式可能被视为一种更实用的治疗方法，我们推测它可能更常用于那些面临就医障碍的患者。
查询国家癌症数据库（2018 - 2020年）中接受手术或立体定向放射治疗（48 - 60 Gy，3 - 5分次）的临床IA期非小细胞肺癌患者，排除有手术禁忌症的患者。具有以下所有特征的患者被归类为面临“高就医障碍”：收入低于全国中位数水平、缺乏私人保险、在社区医疗机构接受治疗以及居住在非大都市地区。使用多变量逻辑回归分析，评估高就医障碍与立体定向放射治疗使用之间的关联。
共纳入60829例患者，其中3382例（5.6%）面临高就医障碍。其中，13535例（22.3%）接受了立体定向放射治疗，47294例（77.7%）接受了手术。总体而言，与接受手术的患者相比，接受立体定向放射治疗的患者面临高就医障碍的比例更高（8.6%对4.7%，P < 0.001）。地理区域与立体定向放射治疗的应用相关（P < 0.001）。这种关联在面临高就医障碍的患者中更为明显。在多变量分析中，面临高就医障碍仍与接受立体定向放射治疗相关（比值比：1.46，95%可信区间1.35 - 1.58）。
立体定向放射治疗在面临就医障碍的患者中应用更为普遍。需要进一步研究以阐明这种治疗方式在早期肺癌中的作用。
