Effectiveness of chemotherapy for advanced lung cancer in the elderly: Instrumental variable and propensity analysis
Effectiveness of chemotherapy for advanced lung cancer in the elderly: Instrumental variable and propensity analysis
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DOI：
10.1200/jco.2001.19.4.1064
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发表时间：
2001-02-15
影响因子：
45.3
通讯作者：
Weeks, JC
中科院分区：
文献类型：
--
作者：
Earle, CC;Tsai, JS;Weeks, JC
目的：比较四期非小细胞肺癌(NSCLC)老年患者常规化疗的有效性和随机试验中观察到的疗效。患者和方法：我们使用工具变量分析(IVA)和倾向性评分(PS)来模拟来自生存、流行病学和最终结果(SEER)肿瘤登记的65岁以上患者回顾队列中的随机试验的条件。结果：在6,232名老年患者中，工具变量估计值显示，化疗使患者的中位生存期延长33天，一年生存率提高9%。在Cox回归模型中，化疗的风险比为0.81(95%可信区间为0.76至0.85)。当在倾向分数五分位数内单独分析生存时，风险比都是相似的，范围从0.78到0.85。这些结果与一项大型荟萃分析的结果相当，后者发现65岁以上患者亚组的风险比为0.87。结论：IV期NSCLC化疗似乎对老年患者和合并疾病的患者有效，与主要包含更年轻、高度选择的患者的随机试验的疗效相似。所有合适的患者都应该有机会考虑对转移性非小细胞肺癌进行姑息化疗。
Purpose: To compare the effectiveness of chemotherapy given to elderly patients in routine practice for stage IV non-small-cell lung cancer (NSCLC) with the efficacy observed in randomized trials.Patients and Methods: We used instrumental variable analysis (IVA) and propensity scores (PS) to simulate the conditions of a randomized trial in a retrospective cohort of patients over age 65 from the Survival, Epidemiology, and End Results (SEER) tumor registry. Geographic variation in chemotherapy use served as the instrument for the IVA analysis, and propensity scores were calculated with a logistic model based on patient disease and sociodemographic characteristics.Results: Among 6,232 elderly patients, the instrumental variable estimate indicated an increase in median survival of 33 days and an improvement in I-year survival of 9% attributable to chemotherapy. In a Cox regression model, chemotherapy administration was associated with a hazard ratio of 0.81 (95% confidence interval, 0.76 to 0.85). When survival was analyzed separately within propensity score quintiles, the hazard ratios were all similar, ranging from 0.78 to 0.85. These results are comparable with those of a large meta-analysis, which found a hazard ratio of 0.87 in the subgroup of patients over age 65.Conclusion: Chemotherapy for stage IV NSCLC seems to have effectiveness for elderly patients and those with comorbid conditions that is similar to the efficacy seen in randomized trials containing mostly younger, highly selected patients. All suitable patients should be given the opportunity to consider palliative chemotherapy for metastatic NSCLC.