Lung Cancer Survival Trends in the Veterans Health Administration.
Lung Cancer Survival Trends in the Veterans Health Administration.
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退伍军人健康管理局的肺癌生存趋势。
DOI：
10.1016/j.cllc.2024.02.009
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发表时间：
2024
影响因子：
3.6
通讯作者：
Behera,Madhusmita
中科院分区：
文献类型：
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作者：
Moghanaki,Drew;Taylor,James;Bryant,AlexK;Vitzthum,LucasK;Sebastian,Nikhil;Gutman,David;Burns,Abigail;Huang,Zhonglu;Lewis,JenniferA;Spalluto,LucyB;Williams,ChristinaD;Sullivan,DonaldR;Slatore,ChristopherG;Behera,Madhusmita
在美国，肺癌的生存率正在提高。我们调查了美国最大的综合医疗保健系统——退伍军人健康管理局（VHA）内是否存在类似的趋势。材料和方法使用Kaplan-Meier估计和线性回归分析来自退伍军人事务中心癌症登记处的数据的时间生存趋势。结果2010年至2017年，共有54922名退伍军人被确诊为肺癌。组织学分为非小细胞肺癌（NSCLC）（64.2%）、小细胞肺癌（SCLC）（12.9%）和“其他”（22.9%）。I期比例由18.1%上升至30.4%，IV期比例由38.9%下降至34.6% （p均< 0.001）。3年总生存率（OS）在I期（58.6%至68.4%，P< 0.001）、II期（35.5%至48.4%，P< 0.001）、III期（18.7%至29.4%，P< 0.001）和IV期（3.4%至7.8%，P< 0.001）均有改善。对于NSCLC，中位OS从12个月增加到21个月（P< 0.001）， 3年OS从24.1%增加到38.3% （P< 0.001）。对于SCLC，中位OS保持不变（8 - 9个月，P= 0.10），而3年OS从9.1%增加到12.3% （P= 0.014）。黑人退伍军人与白人退伍军人相比，非小细胞肺癌的OS相似（P= .81），而SCLC的OS更高（P= .003）。结论VHA治疗可提高肺癌患者的生存率。与白人退伍军人相比，黑人退伍军人的存活率相似或更高。在地理和社会经济不同的人群中观察到的种族平等结果值得进一步调查，以更好地理解和复制其他医疗保健系统中的这一成就。
IntroductionLung cancer survival is improving in the United States. We investigated whether there was a similar trend within the Veterans Health Administration (VHA), the largest integrated healthcare system in the United States.Materials and MethodsData from the Veterans Affairs Central Cancer Registry were analyzed for temporal survival trends using Kaplan-Meier estimates and linear regression.ResultsA total number of 54,922 Veterans were identified with lung cancer diagnosed from 2010 to 2017. Histologies were classified as non–small-cell lung cancer (NSCLC) (64.2%), small cell lung cancer (SCLC) (12.9%), and ‘other’ (22.9%). The proportion with stage I increased from 18.1% to 30.4%, while stage IV decreased from 38.9% to 34.6% (bothP< .001). The 3-year overall survival (OS) improved for stage I (58.6% to 68.4%,P< .001), stage II (35.5% to 48.4%,P< .001), stage III (18.7% to 29.4%,P< .001), and stage IV (3.4% to 7.8%,P< .001). For NSCLC, the median OS increased from 12 to 21 months (P< .001), and the 3-year OS increased from 24.1% to 38.3% (P< .001). For SCLC, the median OS remained unchanged (8 to 9 months,P= .10), while the 3-year OS increased from 9.1% to 12.3% (P= .014). Compared to White Veterans, Black Veterans with NSCLC had similar OS (P= .81), and those with SCLC had higher OS (P= .003).ConclusionLung cancer survival is improving within the VHA. Compared to White Veterans, Black Veterans had similar or higher survival rates. The observed racial equity in outcomes within a geographically and socioeconomically diverse population warrants further investigation to better understand and replicate this achievement in other healthcare systems.