The Effect of Advances in Lung-Cancer Treatment on Population Mortality.
The Effect of Advances in Lung-Cancer Treatment on Population Mortality.
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DOI：
10.1056/nejmoa1916623
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发表时间：
2020-08-13
期刊：
影响因子：
--
通讯作者：
Feuer EJ
中科院分区：
文献类型：
--
作者：
Howlader N;Forjaz G;Mooradian MJ;Meza R;Kong CY;Cronin KA;Mariotto AB;Lowy DR;Feuer EJ
肺癌由不同的亚型组成，包括非小细胞肺癌(NSCLC)和小细胞肺癌(SCLC)。尽管美国肺癌的总死亡率一直在下降，但人们对人口层面上癌症亚型的死亡率趋势知之甚少，因为死亡证明没有记录亚型信息。使用监测、流行病学和最终结果(SEER)领域的数据，我们评估了肺癌死亡率，并将肺癌死亡与SEER癌症登记中的发病病例联系起来。这使我们能够评估归因于特定亚型的人口水平死亡率趋势(基于发病率的死亡率)。我们还根据癌症亚型、性别和历年评估了肺癌的发病率和存活率。使用Joinpoint软件评估发病率的变化和基于发病率的死亡率趋势。非小细胞肺癌死亡率的下降速度甚至快于这一亚型的发病率，这种下降与随着时间的推移存活率的显著改善有关，这与靶向治疗获得批准的时间相对应。在男性中，从2013年到2016年，非小细胞肺癌的发病率死亡率每年下降6.3%，而从2008年到2016年，发病率每年下降3.1%。相应的肺癌特异性生存率从2001年确诊的男性非小细胞肺癌患者的26%提高到2014年确诊的男性患者的35%。在所有种族和民族中都发现了这种存活率的改善。在患有非小细胞肺癌的女性中也发现了类似的模式。相比之下，小细胞肺癌的死亡率几乎完全由于发病率的下降而下降，而生存率并没有改善。这一结果与我们研究的时间框架内小细胞肺癌治疗进展有限有关。从2013年到2016年，美国非小细胞肺癌的人口死亡率大幅下降，确诊后的存活率大幅提高。我们的分析表明，随着治疗的进步--特别是靶向治疗的批准和使用--发病率的下降可能解释了这一时期观察到的死亡率下降的原因。
Lung cancer is made up of distinct subtypes, including non–small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC). Although overall mortality from lung cancer has been declining in the United States, little is known about mortality trends according to cancer subtype at the population level because death certificates do not record subtype information. Using data from Surveillance, Epidemiology, and End Results (SEER) areas, we assessed lung-cancer mortality and linked deaths from lung cancer to incident cases in SEER cancer registries. This allowed us to evaluate population-level mortality trends attributed to specific subtypes (incidence-based mortality). We also evaluated lung-cancer incidence and survival according to cancer subtype, sex, and calendar year. Joinpoint software was used to assess changes in incidence and trends in incidence-based mortality. Mortality from NSCLC decreased even faster than the incidence of this subtype, and this decrease was associated with a substantial improvement in survival over time that corresponded to the timing of approval of targeted therapy. Among men, incidence-based mortality from NSCLC decreased 6.3% annually from 2013 through 2016, whereas the incidence decreased 3.1% annually from 2008 through 2016. Corresponding lung cancer–specific survival improved from 26% among men with NSCLC that was diagnosed in 2001 to 35% among those in whom it was diagnosed in 2014. This improvement in survival was found across all races and ethnic groups. Similar patterns were found among women with NSCLC. In contrast, mortality from SCLC declined almost entirely as a result of declining incidence, with no improvement in survival. This result correlates with limited treatment advances for SCLC in the time frame we examined. Population-level mortality from NSCLC in the United States fell sharply from 2013 to 2016, and survival after diagnosis improved substantially. Our analysis suggests that a reduction in incidence along with treatment advances — particularly approvals for and use of targeted therapies — is likely to explain the reduction in mortality observed during this period.