Prior cancer does not adversely affect survival in locally advanced lung cancer: A national SEER-medicare analysis
Prior cancer does not adversely affect survival in locally advanced lung cancer: A national SEER-medicare analysis
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DOI：
10.1016/j.lungcan.2016.05.029
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发表时间：
2016-08-01
期刊：
影响因子：
5.3
通讯作者：
Gerber, David E.
中科院分区：
文献类型：
--
作者：
Laccetti, Andrew L.;Pruitt, Sandi L.;Gerber, David E.
引言：局部晚期非小细胞肺癌的治疗是胸部肿瘤学中最具争议的领域之一。在这一人群中，既往癌症史经常导致从临床试验中排除，并可能影响治疗决策。因此，我们确定了这些patients.Materials和方法的患病率和预后的影响，以前的癌症：我们确定了1992年至2009年诊断为局部晚期肺癌的患者>65岁，在监测，流行病学，和最终结果医疗保险链接的数据集。我们通过患病率、类型、分期和时间来描述既往癌症。我们使用倾向评分调整的考克斯回归分析比较了有和无既往癌症患者的全因和肺癌特异性生存率。结果：纳入了51,542例局部晚期肺癌患者; 15.8%有既往癌症史。前列腺（25%），胃肠道（17%），乳腺（16%）和其他泌尿生殖系统（15%）是最常见的癌症类型，76%的癌症是局部或原位阶段。大约一半（54%）的既往癌症是在索引肺癌日期的5年内诊断出来的。有癌症病史的患者（倾向评分校正的风险比[HR] 0.96; 95% CI，0.94-0.99; P = 0.005）和改善的肺癌特异性（HR 0.84; 95%CI，0.81-0.86; P < 0.001）生存率。对于局部晚期肺癌患者，既往癌症不会对临床结局产生不利影响。临床试验不应排除有局部晚期肺癌和既往癌症史的患者，如果适当，应提供积极的、可能治愈的治疗。(C)2016爱思唯尔爱尔兰有限公司版权所有。
Introduction: Management of locally advanced non-small cell lung cancer is among the most highly contested areas in thoracic oncology. In this population, a history of prior cancer frequently results in exclusion from clinical trials and may influence therapeutic decisions. We therefore determined prevalence and prognostic impact of prior cancer among these patients.Materials and methods: We identified patients >65 years of age diagnosed 1992-2009 with locally advanced lung cancer in the Surveillance, Epidemiology, and End Results-Medicare linked dataset. We characterized prior cancer by prevalence, type, stage, and timing. We compared all-cause and lung cancer specific survival between patients with and without prior cancer using propensity score-adjusted Cox regression.Results: 51,542 locally advanced lung cancer patients were included; 15.8% had a history of prior cancer. Prostate (25%), gastrointestinal (17%), breast (16%), and other genitourinary (15%) were the most common types of prior cancer, and 76% percent of prior cancers were localized or in situ stage. Approximately half (54%) of prior cancers were diagnosed within 5 years of the index lung cancer date. Patients with prior cancer had similar (propensity-score adjusted hazard ratio [HR] 0.96; 95% CI, 0.94-0.99; P = 0.005) and improved lung cancer-specific (HR 0.84; 95% CI, 0.81-0.86; P < 0.001) survival compared to patients with no prior cancer.Conclusions: For patients with locally advanced lung cancer, prior cancer does not adversely impact clinical outcomes. Patients with locally advanced lung cancer and a history of prior cancer should not be excluded from clinical trials, and should be offered aggressive, potentially curative therapies if otherwise appropriate. (C) 2016 Elsevier Ireland Ltd. All rights reserved.