Overall Survival Among Patients With De Novo Stage IV Metastatic and Distant Metastatic Recurrent Non-Small Cell Lung Cancer.
Overall Survival Among Patients With De Novo Stage IV Metastatic and Distant Metastatic Recurrent Non-Small Cell Lung Cancer.
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DOI：
10.1001/jamanetworkopen.2023.35813
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发表时间：
2023-09-05
影响因子：
13.8
通讯作者：
Han, Summer S.
中科院分区：
文献类型：
--
作者：
Su, Chloe C.;Wu, Julie T.;Choi, Eunji;Myall, Nathaniel J.;Neal, Joel W.;Kurian, Allison W.;Stehr, Henning;Wood, Douglas;Henry, Solomon M.;Backhus, Leah M.;Leung, Ann N.;Wakelee, Heather A.;Han, Summer S.
这项队列研究评估了原发IV期和远处复发转移性非小细胞肺癌之间是否存在生存差异。原发性IV期和远处复发转移性非小细胞肺癌（NSCLC）的生存率是否存在差异？在一项660名受试者的队列研究中，远处复发NSCLC患者的生存率显著高于新发疾病患者，这在一项独立队列中得到了验证。这些结果表明，在未来的临床试验设计中可以考虑将转移性疾病类型作为与结局相关的因素，以确保基线患者特征的平衡。尽管最近在治疗方面取得了突破，但晚期肺癌仍然构成了治疗挑战。转移性肺癌患者的生存特征仍不清楚转移性疾病类型（即，新发IV期vs远处复发）。评估转移性疾病类型与非小细胞肺癌（NSCLC）患者总生存期（OS）的相关性，并确定任何生存差异的潜在机制。在旧金山弗朗西斯科湾区三级转诊中心进行的美国全国人群队列研究，使用来自国家肺筛查试验（NLST）的受试者数据（2002年至2004年入组并随访长达7年）作为主要队列，以及来自斯坦福大学医疗保健（SHC）的患者数据在2009年至2019年期间进行诊断，并随访长达13年作为验证队列。纳入了NLST中新发转移性或远处复发性NSCLC诊断的受试者。数据分析时间为2021年1月至2023年3月。原发IV期vs远处复发性转移性疾病。诊断转移性疾病后的OS。NLST和SHC队列分别包括660例和180例受试者（411例男性[62.3%] vs 109例男性[60.6%]，602例白色受试者[91.2%] vs 111例白色受试者[61.7%]，转移时的平均[SD]年龄分别为66.8 [5.5] vs 71.4 [7.9]岁）。在NLST中，远处复发患者的OS显著优于新发转移患者（校正风险比[aHR]，0.72; 95%CI，0.60-0.87; P <0.001），在SHC中也是如此（aHR，0.64; 95%CI，0.43-0.96; P = 0.03）。在SHC中，原发性转移的患者更常进展至骨（63例新发转移患者[52.5%] vs 19例远处复发患者[31.7%]）或胸膜（40例新发转移患者[33.3%] vs 8例远处复发患者[13.3%]）高于远处复发患者，主要通过症状检测（102例患者[85.0%]），而后者治疗后监测（47例患者[78.3%]）。在进一步调整转移部位和检测方法后，主要发现保持一致。在这项队列研究中，远处复发NSCLC患者的OS显著优于新发疾病患者，后者组的特征可能影响总生存期。这一发现有助于为未来的临床试验设计提供信息，以确保基线患者特征的平衡。
This cohort study evaluates whether there is a survival difference between de novo stage IV and distant recurrent metastatic non–small cell lung cancer. Is there a survival difference between de novo stage IV and distant recurrent metastatic non–small cell lung cancer (NSCLC)? In a cohort study of 660 participants, patients with distant recurrent NSCLC had significantly better survival than those with de novo disease, which was validated in an independent cohort. These findings suggest metastatic disease type as a factor associated with outcomes could be considered in future clinical trial design to ensure a balance for baseline patient characteristics. Despite recent breakthroughs in therapy, advanced lung cancer still poses a therapeutic challenge. The survival profile of patients with metastatic lung cancer remains poorly understood by metastatic disease type (ie, de novo stage IV vs distant recurrence). To evaluate the association of metastatic disease type on overall survival (OS) among patients with non–small cell lung cancer (NSCLC) and to identify potential mechanisms underlying any survival difference. Cohort study of a national US population based at a tertiary referral center in the San Francisco Bay Area using participant data from the National Lung Screening Trial (NLST) who were enrolled between 2002 and 2004 and followed up for up to 7 years as the primary cohort and patient data from Stanford Healthcare (SHC) for diagnoses between 2009 and 2019 and followed up for up to 13 years as the validation cohort. Participants from NLST with de novo metastatic or distant recurrent NSCLC diagnoses were included. Data were analyzed from January 2021 to March 2023. De novo stage IV vs distant recurrent metastatic disease. OS after diagnosis of metastatic disease. The NLST and SHC cohort consisted of 660 and 180 participants, respectively (411 men [62.3%] vs 109 men [60.6%], 602 White participants [91.2%] vs 111 White participants [61.7%], and mean [SD] age of 66.8 [5.5] vs 71.4 [7.9] years at metastasis, respectively). Patients with distant recurrence showed significantly better OS than patients with de novo metastasis (adjusted hazard ratio [aHR], 0.72; 95% CI, 0.60-0.87; P < .001) in NLST, which was replicated in SHC (aHR, 0.64; 95% CI, 0.43-0.96; P = .03). In SHC, patients with de novo metastasis more frequently progressed to the bone (63 patients with de novo metastasis [52.5%] vs 19 patients with distant recurrence [31.7%]) or pleura (40 patients with de novo metastasis [33.3%] vs 8 patients with distant recurrence [13.3%]) than patients with distant recurrence and were primarily detected through symptoms (102 patients [85.0%]) as compared with posttreatment surveillance (47 patients [78.3%]) in the latter. The main finding remained consistent after further adjusting for metastasis sites and detection methods. In this cohort study, patients with distant recurrent NSCLC had significantly better OS than those with de novo disease, and the latter group was associated with characteristics that may affect overall survival. This finding can help inform future clinical trial designs to ensure a balance for baseline patient characteristics.
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DOI：
10.6004/jnccn.2020.7668
发表时间：
2021-04-20
期刊：
Journal of the National Comprehensive Cancer Network : JNCCN
影响因子：
--
作者：
Qin A;Zhao S;Miah A;Wei L;Patel S;Johns A;Grogan M;Bertino EM;He K;Shields PG;Kalemkerian GP;Gadgeel SM;Ramnath N;Schneider BJ;Hassan KA;Szerlip N;Chopra Z;Journey S;Waninger J;Spakowicz D;Carbone DP;Presley CJ;Otterson GA;Green MD;Owen DH
通讯作者：
Owen DH
DOI：
10.1016/s0360-3016(02)02814-6
发表时间：
2002-07-15
影响因子：
7
作者：
Etiz, D;Marks, LB;Lind, PA
通讯作者：
Lind, PA
DOI：
10.1186/s13014-014-0283-6
发表时间：
2014-12-13
期刊：
Radiation oncology (London, England)
影响因子：
--
作者：
Koo TR;Moon SH;Lim YJ;Kim JY;Kim Y;Kim TH;Cho KH;Han JY;Lee YJ;Yun T;Kim HT;Lee JS
通讯作者：
Lee JS
使用结构化临床/行政数据检测肺和大肠癌复发，以实现结果和人群健康管理。
影响因子：
3
作者：
Hassett MJ;Uno H;Cronin AM;Carroll NM;Hornbrook MC;Ritzwoller D
通讯作者：
Ritzwoller D
影响因子：
5.3
作者：
Riihimaeki, M.;Hemminki, A.;Hemminki, K.
通讯作者：
Hemminki, K.