Increasing Rates of No Treatment in Advanced-Stage Non-Small Cell Lung Cancer Patients: A Propensity-Matched Analysis.
Increasing Rates of No Treatment in Advanced-Stage Non-Small Cell Lung Cancer Patients: A Propensity-Matched Analysis.
复制标题
DOI：
10.1016/j.jtho.2016.11.2221
复制
发表时间：
2017-03
期刊：
影响因子：
--
通讯作者：
Canter RJ
中科院分区：
文献类型：
--
作者：
David EA;Daly ME;Li CS;Chiu CL;Cooke DT;Brown LM;Melnikow J;Kelly K;Canter RJ
非小细胞肺癌（NSCLC）的治疗和生存结局在III期或IV期患者中差异很大，但尚未对未经治疗的NSCLC患者进行批判性分析以评估可改善的结局。我们评估了NSCLC的治疗趋势及其与肿瘤学结局的相关性，假设有大量未经治疗的患者与接受治疗的患者相似。使用线性回归计算治疗利用率的趋势。Kaplan-Meier和考克斯回归模型用于确定接受治疗的预测因素。倾向匹配用于比较治疗与未治疗患者亚组的生存率。从1998年至2012年国家癌症数据库中发现了原发性非小细胞肺癌患者，其中21%（190，539）的患者未接受治疗。对于IIIA期和IV期，未经治疗的患者比例在研究期间分别增加了0.21%和0.4%（p= 0.003，<0.0001）。无论分期如何，未经治疗的患者的OS显著较短（p<0.0001）。对6,144对接受放化疗的IIIA期患者对进行的倾向性匹配分析证实，未经治疗的患者OS较短（中位数，16.5 vs 6.1个月，p <0.0001）。对于19，046例接受化疗与未接受治疗的IV期患者对，获得了相似的结果（中位OS，9.3 vs 2.0个月，p<0.0001）。未经治疗的IIIA期和IV期患者的比例正在增加。晚期患者的生存结局上级治疗，与选择偏倚无关。在选择放弃治疗之前，应仔细评估治疗的益处和风险。
Variation in treatment and survival outcomes for Non–Small Cell Lung Cancer (NSCLC) is high among patients with stage III or IV, but untreated NSCLC patients have not been critically analyzed to evaluate for improvable outcomes. We evaluated treatment trends and their association with oncologic outcomes for NSCLC, hypothesizing that there are a substantial number of untreated patients who are similar to patients who undergo treatment. Linear regression was used to calculate trends in utilization of treatment. Kaplan-Meier and Cox regression modeling were used to determine predictors of receiving treatment. Propensity-matching was used to compare survival among subsets of treated versus untreated patients. Patients with primary NSCLC were identified from the National Cancer Data base from 1998–2012 and 21% (190,539) of patients received no treatment. For stage IIIA and IV, the proportion of untreated patients increased over the study period by 0.21% and 0.4% respectively (p= 0.003, <0.0001). Regardless of stage, untreated patients had significantly shorter OS (p<0.0001). Propensity-matched analyses of 6,144 stage IIIA patient pairs treated with chemoradiation vs no treatment confirmed shorter OS for untreated patients (Median, 16.5 vs 6.1 months, p <0.0001). For 19,046 stage IV patient pairs treated with chemotherapy vs no treatment, similar results were obtained (Median OS, 9.3 vs 2.0 months, p<0.0001). The proportion of untreated stage IIIA and IV patients is increasing. Survival outcomes among advanced stage patients are superior with treatment, independent of selection bias. The benefits and risks of treatment should be carefully assessed prior to choosing to forego treatment.
登录
查看更多内容
影响因子：
3.7
作者：
Wao H;Mhaskar R;Kumar A;Miladinovic B;Djulbegovic B
通讯作者：
Djulbegovic B
影响因子：
6.2
作者：
Small, Alexander C.;Tsao, Che-Kai;Galsky, Matthew D.
通讯作者：
Galsky, Matthew D.
影响因子：
5.3
作者：
Johnson, Asal Mohamadi;Hines, Robert B.;Bayakly, A. Rana
通讯作者：
Bayakly, A. Rana
影响因子：
3.7
作者：
Bilimoria KY;Stewart AK;Winchester DP;Ko CY
通讯作者：
Ko CY
影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA