I-III期非小细胞肺癌中的最佳支持治疗：真实世界研究人群中因放弃根治性治疗原因而异的生存分析
Best supportive care in stage I-III non-small cell lung cancer: survival by reason for curative treatment omission in a real-world study population.
作者
作者单位
- Department of Pulmonology, Radboud University Medical Center, Nijmegen, The Netherlands.
- Department of Pulmonology, Rijnstate Hospital, Arnhem, The Netherlands.
- Department of Computational Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.
- Department of Medical Affairs, MSD B.V., Haarlem, The Netherlands.
- Department of IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands.
摘要
中文
尽管I-III期非小细胞肺癌（NSCLC）治疗取得了进展，但被认为不适合或拒绝治疗的患者仍被放弃根治性治疗。关于接受首选最佳支持治疗（BSC）的患者的总生存和癌症相关生存结局的真实世界数据有限。本研究的主要目的是比较不同BSC原因（患者偏好与其他因素）的中位总生存（OS）。我们回顾性分析了2015年至2019年在荷兰诊断为I-III期NSCLC患者的总生存和肺癌特异性生存（LCSS）。患者接受了首选BSC或根治性治疗（手术、放疗或放化疗）。BSC队列按主要决定因素分类：（I）患者偏好；（II）体能状态不足；或（III）相关合并症。使用log-rank检验和Cox回归模型比较生存数据。在1,895例患者中，234例（12%）接受了首选BSC，其中82例基于患者偏好。总BSC队列的中位OS为5.9个月，患者偏好队列为9.6个月，而根治性治疗队列为54.1个月[风险比（HR）0.17；95%置信区间（CI）：0.13-0.22；P<0.001]。总BSC队列和患者偏好队列的中位LCSS分别为8.9和16.4个月，而根治性治疗队列未达到（HR 0.15；95% CI：0.11-0.21；P<0.001）。在调整相关混杂因素后，这些生存差异仍然显著。在常规临床实践中，相当比例的I-III期NSCLC患者因医学原因或患者偏好接受了首选BSC。无论哪种情况，放弃根治性治疗均导致生存结局显著降低。我们的数据为门诊肿瘤科的治疗决策提供了有针对性的证据。
English
Despite advances in stage I-III non-small cell lung cancer (NSCLC) treatment, curative-intent therapy is withheld in patients deemed ineligible or preferring no treatment. Limited real-world data exist on overall and cancer-related survival outcomes in patients receiving primary best supportive care (BSC). The main aim of this study was to compare median overall survival (OS) by reason for BSC (patient preference versus other factors). We retrospectively analyzed overall and lung cancer-specific survival (LCSS) in patients with stage I-III NSCLC diagnosed between 2015 and 2019 in the Netherlands. Patients received primary BSC or curative treatment (surgery, radiotherapy or chemoradiation). The BSC cohort was categorized by main decisive factor: (I) patient preference; (II) insufficient performance status; or (III) relevant comorbidities. Survival data were compared using log-rank tests and Cox regression models. Out of 1,895 patients, 234 (12%) received primary BSC, including 82 based on patient preference. Median OS was 5.9 months in the total BCS cohort and 9.6 months in the patient-preference cohort, compared to 54.1 months in the curative treatment cohort [hazard ratio (HR) 0.17; 95% confidence interval (CI): 0.13-0.22; P<0.001]. Median LCSS was 8.9 and 16.4 months in the total BSC and patient-preference cohort, respectively, versus not reached in the curative treatment cohort (HR 0.15; 95% CI: 0.11-0.21; P<0.001). These survival differences remained significant after adjusting for relevant confounders. In routine clinical practice, primary BSC was provided in a substantial proportion of patients with stage I-III NSCLC, due to medical reasons or patient preference. In either case, omission of curative treatment resulted in significantly reduced survival outcomes. Our data offer targeted evidence to guide treatment decisions in the outpatient oncology clinic.
分类与指标
- 研究类型
- 临床研究
- 病种
- 肺癌
- JCR 分区
- Q2
- 影响因子
- 3.4
- 新锐分区
- 3区