Improved outcomes associated with higher surgery rates for older patients with early stage nonsmall cell lung cancer.
Improved outcomes associated with higher surgery rates for older patients with early stage nonsmall cell lung cancer.
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DOI：
10.1002/cncr.26363
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发表时间：
2012-03-01
期刊：
影响因子：
6.2
通讯作者：
Keating NL
中科院分区：
文献类型：
--
作者：
Gray SW;Landrum MB;Lamont EB;McNeil BJ;Jaklitsch MT;Keating NL
尽管手术为早期非小细胞肺癌 (NSCLC) 患者提供了最大的治愈机会，但年龄较大和病情较重的患者往往无法接受切除术。手术对于老年患者和患有多种合并症的患者的益处尚不确定。我们确定了一个由 17,638 名医疗保险受益人组成的全国队列，他们年龄≥66 岁，居住在监测、流行病学和最终结果 (SEER) 地区，在 2001 年至 2005 年期间被诊断为 I 期或 II 期 NSCLC。我们比较了早期肺癌治愈性手术率高和低的地区，以评估老年和病情较重患者的手术效果。我们使用逻辑回归模型通过区域手术率的五分位数来评估死亡率，并调整潜在的混杂因素。不到 63% 的患者在低手术区域接受了手术，而 >79% 的患者在高手术区域接受了手术。高手术区比低手术区接受更多高龄慢性阻塞性肺病患者的手术。高手术率地区的调整后全因一年死亡率为 18.0%，而低手术率地区为 22.8%（手术率每增加 10%，调整后优势比 (OR)=0.89（95% 置信区间 [CI] 0.86–0.93））。高手术率地区的一年肺癌特异性死亡率同样低于低手术率地区（12.0% vs 16.9%），手术率每增加 10%，调整后 OR=0.86（95% CI 0.82-0.91）。 I/II 期 NSCLC 的手术率较高与生存率的提高相关，即使老年患者和病情较重的患者接受切除术也是如此。需要做更多的工作来确定和减少早期非小细胞肺癌的手术障碍。
Although surgery offers the greatest chance of cure for patients with early stage non-small cell lung cancer (NSCLC), older and sicker patients often fail to undergo resection. The benefits of surgery in older patients and patients with multiple co-morbidities are uncertain. We identified a national cohort of 17,638 Medicare beneficiaries, aged ≥66 years living in Surveillance, Epidemiology, and End Results (SEER) areas who were diagnosed with stage I or II NSCLC during 2001–2005. We compared areas with high and low rates of curative surgery for early-stage lung cancer to estimate the effectiveness of surgery in older and sicker patients. We used logistic regression models to assess mortality by quintile of area-level surgery rates, adjusting for potential confounders. Fewer than 63% of patients underwent surgery in low-surgery areas while >79% underwent surgery in high-surgery areas. High-surgery areas operated on more patients with advanced age and COPD than low-surgery areas. Adjusted all-cause one year mortality was 18.0% in high-surgery areas vs. 22.8% in low-surgery areas (adjusted odds ratio (OR)=0.89 (95% confidence interval [CI] 0.86–0.93) for each 10% increase in surgery rates). One year lung-cancer-specific mortality was similarly lower in high-versus low-surgery areas (12.0% versus 16.9%), adjusted OR=0.86 (95% CI 0.82–0.91) for each 10% increase in surgery rates. Higher rates of surgery for stage I/II NSCLC are associated with improved survival, even when older patients and sicker patients undergo resection. More work is needed to identify and reduce barriers to surgery for early-stage NSCLC.
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影响因子：
3.7
作者：
Rogers SO Jr;Gray SW;Landrum MB;Klabunde CN;Kahn KL;Fletcher RH;Clauser S;Tisnado D;Doucette W;Keating NL
通讯作者：
Keating NL
影响因子：
7.2
作者：
Klabunde, CN;Potosky, AL;Warren, JL
通讯作者：
Warren, JL
影响因子：
39.2
作者：
Keating, Nancy L.;Landrum, Mary Beth;McNeil, Barbara J.
通讯作者：
McNeil, Barbara J.
影响因子：
24.3
作者：
Damhuis, RAM;Schutte, PR
通讯作者：
Schutte, PR
影响因子：
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作者：
Chambers, Anthony;Routledge, Tom;Scarci, Marco
通讯作者：
Scarci, Marco