Update of Incidence, Prevalence, Survival, and Initial Treatment in Patients With Non-Small Cell Lung Cancer in the US
Update of Incidence, Prevalence, Survival, and Initial Treatment in Patients With Non-Small Cell Lung Cancer in the US
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DOI：
10.1001/jamaoncol.2021.4932
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发表时间：
2021-10-21
期刊：
影响因子：
28.4
通讯作者：
Chou, Engels
中科院分区：
文献类型：
--
作者：
Ganti, Apar Kishor;Klein, Alyssa B.;Chou, Engels
本横断面流行病学分析计算了非小细胞肺癌患者的发病率、患病率和生存率的最新流行病学估计值，并描述了美国总体和分期的初始治疗情况。重要性需要更新美国非小细胞肺癌（NSCLC）的估计值。目的计算美国NSCLC的最新流行病学估计值。设计、设置和参与者这项横断面流行病学分析使用了美国癌症登记处最近发布的数据。基于人群的美国癌症统计（USCS）数据库（2010-2017），包括监测、流行病学和最终结果（SEER）计划和国家癌症登记计划（NPCR）（统称SEER-NPCR），提供了NSCLC发病率估计值。SEER-18数据库提供了NSCLC分期的发病率、患病率、生存率和初始治疗数据。纳入了根据国际肿瘤疾病分类第三版形态学编码诊断为NSCLC的18岁或以上成人。主要结果和测量：每10万人的年龄调整的NSCLC年发病率;每10万人的年患病率;生存率;初始治疗。由于数据库发布延迟，2017年的发病率数据可用，2016年的其他参数可用。分析于二零二零年六月至二零二零年七月期间进行。结果2010年至2017年期间，美国记录了128万例新发NSCLC病例（SEER-NPCR：53%为男性; 67% ≥ 65岁）。从2010年至2017年，每10万人的NSCLC发病率从46.4降至40.9（年龄= 65岁：259.9降至230.0）; II、IIIA和IIIB期NSCLC的发病率稳定，IV期从21.7略微降至19.6，而I期发病率从10.8增至13.2。从2010年到2016年，每10万人的NSCLC患病率从175.3增加到198.3（全国SEER-18预测）;年轻患者的患病率增加（77.5至87.9），但老年患者的患病率下降（825.1至812.4）。周期生存分析发现，26.4%的患者存活5年，高于先前报道的水平。接受放疗作为单一初始治疗的I期NSCLC比例从2010年的14.7%显著上升至2016年的25.7%。年龄≥ 65岁的IV期NSCLC患者最有可能未经治疗（38.3%）。结论和相关性横断面流行病学分析的结果表明，诊断时I期NSCLC的发病率增加可能反映了对偶发结节的评估改善。接受治疗的65岁或以上IV期NSCLC患者比例较小。早期检测和有效治疗的可用性可能是增加总体NSCLC患病率的基础，并且高于先前报道的生存率。问题美国最新数据揭示了非小细胞肺癌（NSCLC）流行病学的哪些方面？在这项横断面流行病学分析中，NSCLC发病率从2010年到2017年总体下降，但I期疾病患者的发病率上升。NSCLC的患病率增加，估计5年生存率为26.4%; 65岁或以上的IV期疾病患者中有很高比例被归类为未接受治疗。诊断时I期NSCLC发病率的增加可能反映了对偶发结节的评估得到了改善;更有效的治疗方法的可用性可能解释了总体患病率增加和5年生存率增加的原因，尽管65岁或以上的IV期NSCLC患者可能治疗不足。
This cross-sectional epidemiological analysis calculated the most recent epidemiological estimates of incidence, prevalence, and survival in patients with non-small cell lung cancer, and describes initial treatment overall and by stage in the US.Importance Updated estimates of non-small cell lung cancer (NSCLC) in the US are needed. Objective To calculate the most recent epidemiologic estimates of NSCLC in the US. Design, Setting, and Participants This cross-sectional epidemiological analysis used the most recently released data from US cancer registries. The population-based US Cancer Statistics (USCS) database (2010-2017), comprised of the Surveillance, Epidemiology, and End Results (SEER) program and the National Program of Cancer Registries (NPCR) (collectively, SEER-NPCR) provided the NSCLC incidence estimate. The SEER-18 database provided data for incidence, prevalence, survival, and initial treatment by NSCLC stage. Adults aged 18 years or older diagnosed with NSCLC identified by International Classification of Diseases for Oncology, Third Edition, morphology codes were included. Main Outcomes and Measures Annual age-adjusted NSCLC incidence per 100 000 persons; annual prevalence per 100 000 persons; survival rate; initial treatment. Due to database release delays, incidence data were available through 2017, and other parameters through 2016. The analysis was conducted from June 2020 to July 2020. Results There were 1.28 million new NSCLC cases recorded during 2010 to 2017 in the US (SEER-NPCR: 53% male; 67% >= 65 years). From 2010 to 2017, NSCLC incidence per 100 000 decreased from 46.4 to 40.9 overall (age = 65 years: 259.9 to 230.0); the incidence of stage II, IIIA, and IIIB NSCLC was stable, and stage IV decreased slightly from 21.7 to 19.6, whereas stage I incidence increased from 10.8 to 13.2. From 2010 to 2016, NSCLC prevalence per 100 000 increased from 175.3 to 198.3 (nationwide projection of SEER-18); prevalence increased among younger patients (77.5 to 87.9) but decreased among older patients (825.1 to 812.4). Period survival analysis found that 26.4% of patients survived 5 years, which is higher than previously reported. The proportion of stage I NSCLC treated with radiation as single initial treatment rose markedly from 14.7% in 2010 to 25.7% in 2016. Patients with stage IV NSCLC aged 65 years or older were most likely to be untreated (38.3%). Conclusions and Relevance The findings of this cross-sectional epidemiological analysis suggest that the increased incidence of stage I NSCLC at diagnosis likely reflected improved evaluation of incidental nodules. A smaller proportion of patients aged 65 years or older with stage IV NSCLC were treated. Earlier detection and availability of effective treatments may underlie increased overall NSCLC prevalence, and higher than previously reported survival.Question What do the latest US data reveal about non-small cell lung cancer (NSCLC) epidemiology? Findings In this cross-sectional epidemiological analysis, NSCLC incidence decreased from 2010 to 2017 overall, but rose for patients with stage I disease. Prevalence of NSCLC has increased, and estimated 5-year survival was 26.4%; a high proportion of patients with stage IV disease aged 65 or older years were categorized as not treated. Meaning The increased incidence of stage I NSCLC at diagnosis likely reflects improved evaluation of incidental nodules; availability of more effective treatments may explain increased overall prevalence and increased 5-year survival, though patients aged 65 years or older with stage IV NSCLC may be undertreated.