Care of patients with non-small-cell lung cancer stage III - the Central European real-world experience
Care of patients with non-small-cell lung cancer stage III - the Central European real-world experience
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DOI：
10.2478/raon-2020-0026
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发表时间：
2020-06-01
影响因子：
2.4
通讯作者：
Votruba, Jiri
中科院分区：
文献类型：
--
作者：
Zemanova, Milada;Pirker, Robert;Votruba, Jiri
背景资料。非小细胞肺癌(NSCLC)的治疗受到地区特殊性的影响。本研究旨在确定中欧国家现实环境下非小细胞肺癌III期患者的诊断和治疗程序，包括结果，以确定需要改进的领域。这项多中心、前瞻性和非干预性研究收集了网络登记的非小细胞肺癌III期患者的数据，并对其进行了集中分析。2014年3月至2017年3月，入选具有以下特征的患者583例：女性32%，不吸烟者7%；ECOG功能状态(PS)0、1、2和3分别为25%、58%、12%和5%；既往体重减轻21%；鳞癌53%；腺癌38%；EGFR突变10%。分期包括胸部X光(97%)、胸部CT(96%)、PET-CT(27%)、脑成像(20%)、支气管镜(89%)、纤维支气管镜(EBUS)(13%)和CT引导下活检(9%)。诊断为IIIA/IIIB期的患者分别占55%/45%。60%/23%的患者诊断为N_2/N_3结节，29%的患者经手术病理证实。大多数患者(56%)接受了综合治疗。20%的患者接受手术加化疗，34%的患者接受明确的放化疗，26%的患者接受化疗，12%的患者接受放射治疗，5%的患者接受最佳支持治疗(BSC)。中位生存期和无进展生存期分别为16.8(15.3；18.5)和11.2(10.2；12.2)个月。IIIA期、女性、无体重减轻、纵隔淋巴结病理检查、手术和综合治疗与患者的生存时间有关。这项现实世界的研究表明，在中欧国家，III期NSCLC的管理存在广泛的异质性，并建议增加PET-CT成像、脑成像和侵袭性纵隔分期的比率。
Background. Management of non-small-cell lung cancer (NSCLC) is affected by regional specificities. The present study aimed at determining diagnostic and therapeutic procedures including outcome of patients with NSCLC stage III in the realworld setting in Central European countries to define areas for improvements.Patients and methods. This multicentre, prospective and non-interventional study collected data of patients with NSCLC stage III in a web-based registry and analysed them centrally.Results. Between March 2014 and March 2017, patients (n=583) with the following characteristics were entered: 32% females, 7% never-smokers; ECOG performance status (PS) 0, 1, 2 and 3 in 25%, 58%, 12% and 5%, respectively; 21% prior weight loss; 53% squamous carcinoma, 38% adenocarcinoma; 10% EGFR mutations. Staging procedures included chest X-ray (97% of patients), chest CT (96%), PET-CT (27%), brain imaging (20%), bronchoscopy (89%), endobronchial ultrasound (EBUS) (13%) and CT-guided biopsy (9%). Stages IIIA/IIIB were diagnosed in 55%/45% of patients, respectively. N2/N3 nodes were diagnosed in 60%/23% and pathologically confirmed in 29% of patients. Most patients (56%) were treated by combined modalities. Surgery plus chemotherapy was administered to 20%, definitive chemoradiotherapy to 34%, chemotherapy only to 26%, radiotherapy only to 12% and best supportive care (BSC) to 5% of patients. Median survival and progression-free survival times were 16.8 (15.3;18.5) and 11.2 (10.2;12.2) months, respectively. Stage IIIA, female gender, no weight loss, pathological mediastinal lymph node verification, surgery and combined modality therapy were associated with longer survival.Conclusions. The real-world study demonstrated a broad heterogeneity in the management of stage III NSCLC in Central European countries and suggested to increase the rates of PET-CT imaging, brain imaging and invasive mediastinal staging.