Association of Stage Shift and Population Mortality Among Patients With Non-Small Cell Lung Cancer.
Association of Stage Shift and Population Mortality Among Patients With Non-Small Cell Lung Cancer.
复制标题
非小细胞肺癌患者阶段转移和人口死亡率的关联。
DOI：
10.1001/jamanetworkopen.2021.37508
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发表时间：
2021-12-01
影响因子：
13.8
通讯作者：
Taioli E
中科院分区：
文献类型：
--
作者：
Flores R;Patel P;Alpert N;Pyenson B;Taioli E
在评估非小细胞肺癌人群死亡率时，阶段转移在多大程度上是一个混杂变量？在这项包含312 382名患者的队列研究中，在过去十年中，从晚期到早期疾病的阶段转变与肺癌患者死亡率的提高有关。这些发现表明，研究肺癌的治疗方法必须考虑阶段转移以及与生存和死亡率结果的混淆关系。本队列研究调查了2006年至2016年间诊断为非小细胞肺癌的患者阶段转移与人群死亡率的关系。在过去的十年中，通过计算机断层扫描的早期检测和对偶然发现的肺结节更加关注的方法导致了非小细胞肺癌（NSCLC）的人群阶段转移。这种阶段转移可能会严重混淆对新疗法和死亡率结果的评估。目的：探讨非小细胞肺癌分期转移与人群死亡率的关系。这项回顾性队列研究于2020年10月至2021年6月进行，使用来自监测、流行病学和最终结果（SEER）登记的数据评估2006年至2016年所有NSCLC患者。以发病率为基础的死亡率按死亡年份进行评估。为了评估诊断特征的变化，采用χ2检验按年检查临床分期和组织学分布。使用JoinPoint软件计算的平均年变化百分比（AAPC）来评估趋势。Kaplan-Meier生存分析根据分期评估总生存率，并将错过任何分期的患者与报告分期的患者进行比较。最终样本包含312 382例患者；男性166 657例（53.4%），黑人38 201例（12.2%），白人249 062例（79.7%）；中位（IQR）年龄为68岁（60-76岁）；腺癌组织学检查163 086例（52.2%）。从2006年到2016年，诊断5年内基于发病率的死亡率下降（AAPC, - 3.7; 95% CI, - 4.1至- 3.4）。在评估分期转移时，诊断年份与临床分期之间存在显著关联，I/II期诊断从26.5%增加到31.2% (AAPC, 1.5; 95% CI， 0.5至2.5)；III/IV期诊断从70.8%显著下降至66.1% （AAPC, - 0.6; 95% CI, - 1.0至- 0.2）。缺少分期信息与诊断年份无关（AAPC, - 1.6; 95% CI, - 7.4至4.5）。诊断年份与肿瘤组织学有显著相关性（χ2 = 8990.0; P < 0.001）。腺癌的发生率显著增加：2006年为42.9%，2016年为59.0% （AAPC, 3.4; 95% CI， 2.9至3.9）。I/II期的中位生存期（IQR）为57个月（18个月至未达到）；III/IV期为7（2-19）个月；缺期10（2 ~ 28）个月。与已知分期的患者相比，无分期信息的患者的生存期明显低于I/II期患者，III期与IV期患者的生存期差异有统计学意义（log-rank χ2 = 87 125.0; P < .001）。这项队列研究发现死亡率降低与相应的诊断从晚期到早期的转变之间存在关联。这些发现表明，研究肺癌治疗效果的研究必须考虑阶段转移以及与生存和死亡率结果的混淆关联。
To what extent does stage shift act as a confounding variable in the evaluation of population mortality of non–small cell lung cancer? In this cohort study of 312 382 patients, stage shift from later to earlier stage disease over the last decade was associated with improved mortality among people with lung cancer. These findings suggest that studies investigating treatments for lung cancer must take into account stage shift and the confounding association with survival and mortality outcome. This cohort study investigates the association of stage shift with population mortality among patients diagnosed with non–small cell lung cancer between 2006 and 2016. Early detection by computed tomography and a more attention-oriented approach to incidentally identified pulmonary nodules in the last decade has led to population stage shift for non–small cell lung cancer (NSCLC). This stage shift could substantially confound the evaluation of newer therapeutics and mortality outcomes. To investigate the association of stage shift with population mortality among patients with NSCLC. This retrospective cohort study was performed from October 2020 to June 2021 and used data from the Surveillance, Epidemiology, and End Results (SEER) registries to assess all patients from 2006 to 2016 with NSCLC. Incidence-based mortality was evaluated by year-of-death. To assess shifts in diagnostic characteristics, clinical stage and histology distributions were examined by year using χ2 tests. Trends were assessed using the average annual percentage change (AAPC), calculated with JoinPoint software. Kaplan-Meier survival analysis assessed overall survival according to stage and compared those missing any stage with those with a reported stage. The final sample contained 312 382 patients; 166 657 (53.4%) were male, 38 201 (12.2%) were Black, and 249 062 (79.7%) were White; the median (IQR) age was 68 (60-76) years; 163 086 (52.2%) had adenocarcinoma histology. Incidence-based mortality within 5 years of diagnosis decreased from 2006 to 2016 (AAPC, −3.7; 95% CI, −4.1 to −3.4). When assessing stage shift, there was significant association between year-of-diagnosis and clinical stage, with stage I/II diagnosis increasing from 26.5% to 31.2% (AAPC, 1.5; 95% CI, 0.5 to 2.5); and stage III/IV diagnosis decreasing significantly from 70.8% to 66.1% (AAPC, −0.6; 95% CI, −1.0 to −0.2). Missing staging information was not associated with year-of-diagnosis (AAPC, −1.6; 95% CI, −7.4 to 4.5). Year-of-diagnosis was significantly associated with tumor histology (χ2 = 8990.0; P < .001). There was a significant increase in adenocarcinomas: 42.9% in 2006 to 59.0% in 2016 (AAPC, 3.4; 95% CI, 2.9 to 3.9). Median (IQR) survival for stage I/II was 57 months (18 months to not reached); stage III/IV was 7 (2-19) months; and missing stage was 10 (2-28) months. When compared with those with known stage, those without stage information had significantly worse survival than those with stage I/II, with survival between those with stage III and stage IV (log-rank χ2 = 87 125.0; P < .001). This cohort study found an association between decreased mortality and a corresponding diagnostic shift from later to earlier stage. These findings suggest that studies investigating the effect of treatment on lung cancer must take into account stage shift and the confounding association with survival and mortality outcome.
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影响因子：
20.4
作者：
Infante, Maurizio;Chiesa, Giuseppe;Ravasi, Gianluigi
通讯作者：
Ravasi, Gianluigi
影响因子：
39.2
作者：
Moyer, Virginia A.
通讯作者：
Moyer, Virginia A.
影响因子：
45.3
作者：
Horn, Leora;Spigel, David R.;Eberhardt, Wilfried E. E.
通讯作者：
Eberhardt, Wilfried E. E.
影响因子：
5.3
作者：
Jao, Kevin;Tomasini, Pascale;Shepherd, Frances A.
通讯作者：
Shepherd, Frances A.
DOI：
10.1007/s00432-012-1228-9
发表时间：
2012-09-01
影响因子：
3.6
作者：
Becker, N.;Motsch, E.;Delorme, S.
通讯作者：
Delorme, S.