Background

Standard management of non-operable N+ M0 non-small cell lung cancer (NSCLC) is concurrent chemoradiation (CRT). However, some patients receive radiation therapy (RTmono) or chemotherapy (CTmono) as monotherapies. This study investigated the patterns of care in the US and analyzed outcomes with monotherapies.

Materials and Methods

Patients in the National Cancer Database (NCDB) diagnosed in 2004-2013 with N+ M0 NSCLC who did not undergo surgery and received monotherapy with either high dose radiation alone (RTmono) or chemotherapy alone (CTmono) were studied. Patient characteristics and overall survival were compared with descriptive statistics (chi-square, Kruskal-Wallis, logistic regression), Kaplan-Meier and stratified Cox models, and restricted mean survival times (RMST); all used alpha of 0.05.

Results

74,867 patients received CRT (10,915, 15%), CTmono (34,978, 47%), RTmono (2,396, 3%), or no aggressive treatment (26,578, 36%). In multivariable analysis, RTmono was associated with non-Medicare insurance, academic or research facility, Western geography, lower T and N stages, and older age. CTmono had better RMST compared to RTmono: at 3 years, average survival was 17.9 vs 16.1 months (difference 1.8, 95% CI 1.3-2.3); at 5 years, average survival was 21.6 vs 18.7 months (difference 2.9, 95% CI 2.2-3.6). In stratified Cox models, female gender, White race, private insurance, metropolitan location, lower Charlson comorbidity score, lower T/N stage, younger age, and later year of diagnosis had better survival.

Conclusions

Only 15% of non-operable N+ M0 NSCLC patients received definitive CRT. Future studies should focus on patients not receiving concurrent CRT, as outcomes with monotherapies (RTmono or CTmono) are suboptimal.

中文翻译：

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美国患有不可手术的T1-4 N + M0非小细胞肺癌患者的护理模式以及放疗或化疗的单一疗法的结局

背景

不可手术的N + M0非小细胞肺癌（NSCLC）的标准管理是同时放化疗（CRT）。但是，有些患者接受放射疗法（RTmono）或化学疗法（CTmono）作为单一疗法。这项研究调查了美国的护理模式，并分析了单一疗法的结果。

材料和方法

研究了2004-2013年在美国国家癌症数据库（NCDB）中诊断为患有N + M0 NSCLC且未接受手术且仅接受高剂量放射（RTmono）或单纯化疗（CTmono）的单药治疗的患者。将患者特征和总体生存率与描述性统计数据（卡方，Kruskal-Wallis，逻辑回归），Kaplan-Meier和分层Cox模型以及受限平均生存时间（RMST）进行比较；所有使用的alpha为0.05。

结果

74,867例患者接受了CRT（10,915，15％），CTmono（34,978，47％），RTmono（2,396，3％）或没有积极治疗（26,578，36％）。在多变量分析中，RTmono与非医疗保险，学术或研究机构，西方地理，T和N阶段较低以及年龄较大有关。CTmono的RMST优于RTmono：3年时的平均生存期为17.9 vs 16.1个月（差异1.8，95％CI 1.3-2.3）；在5年时，平均生存期为21.6 vs 18.7个月（差异2.9，95％CI 2.2-3.6）。在分层的Cox模型中，女性，白人，私人保险，大都会区，较低的Charlson合并症评分，较低的T / N分期，年龄较小以及诊断晚年的存活率更高。

结论

不可手术的N + M0 NSCLC患者中只有15％接受了明确的CRT。由于单一疗法（RTmono或CTmono）的治疗效果欠佳，因此未来的研究应关注未同时接受CRT的患者。