Warwar Samantha C, Janczewski Lauren M, Rodriguez Gladys M, Wayne Jeffrey D, Bentrem David J
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
J Surg Oncol. 2025 Jun;131(7):1455-1466. doi: 10.1002/jso.28084. Epub 2025 Jan 13.
IO has transformed cancer management, but its adoption in advanced cancer patients varies by tumor type. With more Stage IV patients undergoing surgery, understanding site-specific outcomes in these challenging patients is essential. We aimed to evaluate IO use and survival trends for Stage IV cancer patients across high-incidence cancers in the US.
Patients diagnosed with Stage IV prostate, breast, melanoma, colorectal, renal, bladder, lung, or pancreas cancer were identified from the National Cancer Database (2004-2020). Cochrane-Armitage test and Kaplan-Meier methods assessed IO and overall survival across three periods: 2004-2010, 2011-2015, and 2016-2020.
Among 1 425 731 Stage IV cancer patients, most had lung (50.0%), pancreas (12.5%), and breast cancer (9.3%), while the least had melanoma (2.2%). From periods 1 to 3, IO use increased from 1.0% to 24.6%, notably in melanoma (9.5% to 58.5%, p < 0.001). Melanoma exhibited the greatest survival gains (median survival: 7.1 to 14.9 months). Absolute increases in 3-year overall survival rates ranged from 3.4% in pancreas (1.7% to 5.1%) to 21.4% in melanoma (15.7% to 37.1%).
Utilization of IO is tumor-site specific and associated with improved survival rates for Stage IV cancer, with varied success across types. Variations in receipt highlight ongoing challenges to ensure equitable adoption.
免疫肿瘤学（IO）已经改变了癌症治疗方式，但晚期癌症患者对其的采用情况因肿瘤类型而异。随着越来越多的IV期患者接受手术，了解这些具有挑战性的患者的特定部位结局至关重要。我们旨在评估美国高发癌症中IV期癌症患者的免疫肿瘤学使用情况和生存趋势。
从国家癌症数据库（2004 - 2020年）中识别出被诊断为IV期前列腺癌、乳腺癌、黑色素瘤、结直肠癌、肾癌、膀胱癌、肺癌或胰腺癌的患者。采用Cochrane - Armitage检验和Kaplan - Meier方法评估三个时期（2004 - 2010年、2011 - 2015年和2016 - 2020年）的免疫肿瘤学使用情况和总生存率。
在1425731例IV期癌症患者中，大多数患有肺癌（50.0%）、胰腺癌（12.5%）和乳腺癌（9.3%），而黑色素瘤患者最少（2.2%）。从第1期到第3期，免疫肿瘤学的使用从1.0%增加到24.6%，黑色素瘤患者中尤为明显（从9.5%增加到58.5%，p < 0.001）。黑色素瘤患者的生存获益最大（中位生存期：从7.1个月到14.9个月）。3年总生存率的绝对增幅从胰腺癌的3.4%（从1.7%到5.1%）到黑色素瘤的21.4%（从15.7%到37.1%）不等。
免疫肿瘤学的使用具有肿瘤部位特异性，并且与IV期癌症患者生存率的提高相关，不同类型的成功程度各不相同。接受程度的差异凸显了确保公平采用所面临的持续挑战。
