退伍军人健康管理局中非小细胞肺癌新辅助化疗免疫治疗后的退出
Dropout after Neoadjuvant Chemoimmunotherapy for Non-Small Cell Lung Cancer in the Veterans Health Administration.
作者
作者单位
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO USA. Electronic address: wbrandt@wustl.edu.
- Veterans Affairs St. Louis Health Care System, St. Louis, MO USA.
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO USA.
- Veterans Affairs St. Louis Health Care System, St. Louis, MO USA; Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
- Veterans Affairs St. Louis Health Care System, St. Louis, MO USA; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
- Veterans Affairs St. Louis Health Care System, St. Louis, MO USA; Division of Hematology and Medical Oncology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
- Division of Hematology and Medical Oncology, University of Washington, Seattle, WA USA.
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO USA; Veterans Affairs St. Louis Health Care System, St. Louis, MO USA.
摘要
中文
多项研究表明，接受诱导化疗免疫治疗后手术的晚期非小细胞肺癌患者具有优异的生存率。然而，这些研究中高达 22% 的患者未接受手术切除。描述该队列获取、利用和退出的国家退伍军人健康管理局数据有限。我们试图描述该队列的利用、未进展至手术和结果。使用美国退伍军人健康管理局数据库，我们确定了接受化疗免疫治疗（2021-2024 年）的临床分期（cStage）IB-III-N2 非小细胞肺癌患者。所有患者至少接受 2 个周期 CIO。排除标准包括化疗免疫治疗期间的放射治疗、临床 N3 疾病、>4 个周期化疗免疫治疗或 cStage IV 疾病。描述了临床病理特征和治疗模式。使用 Kaplan-Meier 方法估计总生存期（OS）。总共有 86 名患者符合最终纳入标准：60 名（69.8%）接受了手术，26 名（30.2%）没有。两组具有相似的 cStage、年龄和合并症。在未接受手术的患者中，46.2% 在诱导治疗期间发生远处转移性疾病。整个队列的 2 年 OS 为 80.2%（手术 86.7%；非手术 65.8%）。在我们具有全国代表性的队列中，接受化疗免疫治疗并意向手术切除的患者具有有利的中期生存。然而，近三分之一的患者未接受手术，最常见的原因是疾病进展。这些发现强调需要更好地识别未进展至切除的患者，并为这些患者定义管理策略。
English
Multiple studies have demonstrated excellent survival for patients with advanced non-small cell lung cancer who undergo induction chemoimmunotherapy followed by surgery. However, up to 22% of patients in these studies did not undergo surgical resection. National Veterans Health Administration data outlining the uptake, utilization, and dropout in this cohort are limited. We sought to describe utilization, non-progression to surgery, and outcomes in this cohort. Using the United States Veterans Health Administration database, we identified patients with clinical stage (cStage) IB-III-N2 non-small cell lung cancer who underwent chemoimmunotherapy (2021-2024). All patients received at least 2 cycles CIO. Exclusion criteria included radiation during chemoimmunotherapy, clinical N3 disease, >4 cycles chemoimmunotherapy, or cStage IV disease. Clinicopathological characteristics and treatment patterns were described. Overall survival (OS) was estimated using the Kaplan-Meier method. In total, 86 patients met final inclusion criteria: 60 (69.8%) underwent surgery and 26 (30.2%) did not. The groups had similar cStage, age, and comorbidities. Among patients who did not undergo surgery, 46.2% developed distant metastatic disease during induction therapy. The 2-year OS was 80.2% for the entire cohort (86.7% surgical; 65.8% non-surgical). In our nationally representative cohort, patients undergoing chemoimmunotherapy with intent for surgical resection had favorable intermediate-term survival. however, nearly one-third of patients did not undergo surgery, most commonly due to disease progression. These findings highlight the need to better identify patients who do not progress to resection and define management strategies for these patients.
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
- 5.3