Uryu Kiyoaki, Imamura Yoshinori, Shimoyama Rai, Mase Takahiro, Fujimura Yoshiaki, Hayashi Maki, Ohtaki Megu, Otani Keiko, Hibino Makoto, Horiuchi Shigeto, Fukui Tomoya, Fukai Ryuta, Chihara Yusuke, Iwase Akihiko, Yamada Noriko, Tamura Yukihiro, Harada Hiromasa, Tsuya Asuka, Okabe Takafumi, Fukuoka Masahiro, Minami Hironobu
Department of Medical Oncology, Yao Tokushukai General Hospital, Yao-shi, Osaka 581-0011, Japan.
Cancer Care Promotion Center, University of Fukui Hospital, Yoshida-gun, Fukui 910-1193, Japan.
Jpn J Clin Oncol. 2025 Mar 5;55(3):228-236. doi: 10.1093/jjco/hyae167.
Disparities in public assistance or the urbanization level of a residential region can affect cancer treatment outcomes. This study aimed to investigate whether these factors affect the overall survival (OS) of patients with epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC) using Tokushukai REAL World Data.
We analyzed the clinical data of consecutive patients with NSCLC receiving EGFR-tyrosine kinase inhibitors between April 2010 and March 2020 at 46 Tokushukai Medical Group hospitals in Japan. The patient's insurance coverage status was extracted from electronic medical records, and the urbanization level of residential regions was classified as megalopolis or other according to the secondary medical region. Univariate and multivariate Cox regression analyses were performed to examine the associations between OS and patient/tumor/treatment/socioeconomic-related factors.
In total, 758 patients (58.5% females) were included in the study; 41 patients (5.4%) received public assistance, and 442 patients (58.3%) were categorized under megalopolis in the secondary medical regions. In multivariate Cox regression analyses, there was no significant difference in the OS between non-recipients of public assistance and recipients [hazard ratio (HR) 1.084; 95% confidence intervals (CIs), 0.674-1.744]. There was also no significant difference in the OS between megalopolis and other regions in the secondary medical regions (HR 1.143; 95% CIs, 0.914-1.428).
Our findings suggest that neither the use of public assistance nor the urbanization level in the residential region significantly impacts the prognosis of Japanese patients with EGFR mutation-positive NSCLC.
公共援助或居住地区的城市化水平差异可能会影响癌症治疗结果。本研究旨在利用德洲会真实世界数据，调查这些因素是否会影响表皮生长因子受体（EGFR）突变阳性非小细胞肺癌（NSCLC）患者的总生存期（OS）。
我们分析了2010年4月至2020年3月期间在日本46家德洲会医疗集团医院接受EGFR酪氨酸激酶抑制剂治疗的连续NSCLC患者的临床数据。从电子病历中提取患者的保险覆盖状况，并根据二级医疗区域将居住地区的城市化水平分为大城市或其他地区。进行单因素和多因素Cox回归分析，以检验OS与患者/肿瘤/治疗/社会经济相关因素之间的关联。
本研究共纳入758例患者（女性占58.5%）；41例患者（5.4%）接受公共援助，442例患者（58.3%）在二级医疗区域被归类为大城市。在多因素Cox回归分析中，未接受公共援助者与接受公共援助者的OS无显著差异[风险比（HR）1.084；95%置信区间（CI），0.674-1.744]。二级医疗区域中大城市和其他地区之间的OS也无显著差异（HR 1.143；95%CI，0.914-1.428）。
我们的研究结果表明，公共援助的使用和居住地区的城市化水平均不会显著影响日本EGFR突变阳性NSCLC患者的预后。
