肺癌患者治疗后影像学检查：在纵向队列中遵守监测指南与生存改善相关
Post-Treatment Imaging in Lung Cancer Patients: Adherence to Surveillance Guidelines Is Associated with Improved Survival in a Longitudinal Cohort.
作者
作者单位
- Department of Cardiothoracic Surgery, Division of Thoracic Surgery, Stanford Medicine, Stanford, CA, United States.
- Department of Medicine, Division of Surgical Oncology, VA Palo Alto Healthcare System, Palo Alto, CA, United States.
- VA Puget Sound Healthcare System, Seattle, WA, United States.
- Department of Cardiothoracic Surgery, Division of Thoracic Surgery, Stanford Medicine, Stanford, CA, United States; VA Palo Alto Healthcare System, Palo Alto, CA, United States.
- Department of Medicine, Stanford Medicine, Stanford, CA, United States; VA Palo Alto Healthcare System, Palo Alto, CA, United States.
- VA Puget Sound Healthcare System, Seattle, WA, United States; School of Public Health, University of Washington, Seattle, WA, United States.
- VA Palo Alto Healthcare System, Palo Alto, CA, United States.
- Department of Radiology, Stanford Medicine, Stanford, CA, United States.
- Department of Medicine, Stanford Medicine, Stanford, CA, United States.
- Department of Cardiothoracic Surgery, Division of Thoracic Surgery, Stanford Medicine, Stanford, CA, United States; VA Palo Alto Healthcare System, Palo Alto, CA, United States. Electronic address: lbackhus@stanford.edu.
摘要
中文
非小细胞肺癌（NSCLC）幸存者的监测影像学检查可能降低复发和第二原发肿瘤的死亡率，但由于症状驱动的影像学检查存在混杂因素，其对生存的影响难以评估。我们评估了一项纵向队列中主动监测依从性（ASA）与生存的关系。在退伍军人健康管理局（2008-2016年）中确定了接受根治性治疗且存活超过6个月的I-III期NSCLC患者。使用同期NCCN指南和临床图表抽象定义主动监测依从性。时间-事件分析纳入了时变的ASA暴露，建模为连续变量和已过时间的百分比，并调整临床特征。在复发患者中进行了亚组分析。比较复发时间和复发后生存以评估潜在领先时间偏倚。队列包括5650名患者；主要为白人（73%）、男性（97%）、I期疾病（54%）、仅接受手术治疗（52%）。ASA与死亡风险降低相关（每6个月HR 0.92 [95%CI 0.89-0.95, p<0.001]）。症状驱动的影像学检查与死亡风险降低无关（每6个月HR 1.05 [1.00-1.11, p=0.066]）。在复发患者（N=2199）中，监测检测的中位总生存期为34个月[33, 36]，而症状检测为27个月[24, 30]，p<0.0001。复发时间无显著差异。ASA与显著的生存获益相关，与症状驱动的影像学检查相比，这种获益无法用领先时间偏倚解释，这与先前报告未能证明肺癌治疗后监测益处的结论形成对比。
English
Surveillance imaging for non-small cell lung cancer (NSCLC) survivors may reduce mortality from recurrence and secondary primary tumors, but survival impact is difficult to assess due to confounding from symptom-driven imaging. We evaluated the association between active surveillance adherence (ASA) and survival in a longitudinal cohort. Patients with Stage I-III NSCLC who received curative-intent therapy and survived >6 months were identified within the Veterans Health Administration (2008-2016). Active surveillance adherence (ASA) was defined using contemporaneous NCCN guidelines and clinical chart abstraction. Time-to-event analysis incorporated time-varying ASA exposure, modeled as a continuous variable and as a percentage of time elapsed, with adjustment for clinical characteristics. Subgroup analysis was performed among patients with recurrence. Time to recurrence and post-recurrence survival were compared to evaluate potential lead-time bias. The cohort included 5650 patients; predominantly White (73%), male (97%) with Stage I disease (54%) treated with Surgery alone (52%). ASA was associated with a reduced risk of death, (HR 0.92 per 6 months [95%CI 0.89-0.95, p<0.001]). Symptom- driven imaging was not associated with reduced risk of death (HR 1.05 per 6 months [1.00 -1.11, p=0.066]). In patients with recurrence (N=2199) median overall survival from treatment was 34 months [33, 36] for surveillance-detected vs 27 months [24, 30] for symptom-detected, p<0.0001. Time to recurrence did not differ significantly. ASA was associated with significant survival benefit compared to symptom-driven imaging which is not explained by lead-time bias, contrasting with prior reports failing to demonstrate benefits of surveillance following treatment for lung cancer.
分类与指标
- 研究类型
- 临床研究
- 病种
- 肺癌
- JCR 分区
- Q1
- 影响因子
- 4.7