The objective of this study was to describe the real-world treatment and overall survival (OS) of German patients with a diagnosis of advanced non-small cell lung cancer (aNSCLC), and to explore factors associated with the real-world mortality risk. This was a retrospective German claims data analysis of incident aNSCLC patients. Data were available from 01/01/2011 until 31/12/2016. Identification of eligible patients took place between 01/01/2012–31/12/2015, to allow for at least 1-year pre-index and follow-up periods. Inpatient and outpatient mutation test procedures after aNSCLC diagnosis were observed. Further, prescribed treatments and OS since first (incident) aNSCLC diagnosis and start of respective treatment lines were described both for all patients and presumed EGFR/ALK/ROS-1-positive patients. Factors associated with OS were analyzed in multivariable Cox regression analysis. Overall, 1741 aNSCLC patients were observed (mean age: 66·97 years, female: 29·87%). The mutation test rate within this population was 26·31% (n = 458), 26·6% of these patients (n = 122) received a targeted treatment and were assumed to have a positive EGFR/ALK/ROS-1 test result. Most often prescribed treatments were pemetrexed monotherapy as 1 L (21·23% for all and 11·11% for mutation-positive patients) and erlotinib monotherapy as 2 L (25·83%/38·54%). Median OS since incident diagnosis was 351 days in all and 571 days in mutation-positive patients. In a multivariable Cox regression analysis, higher age, a stage IV disease, a higher number of chronic drugs in the pre-index period and no systemic therapy increased the risk of early death since first aNSCLC diagnosis. On the other hand, female gender and treatment with therapies other than chemotherapy were associated with a lower risk of early death. Despite the introduction of new treatments, the real-world survival prognosis for aNSCLC patients remains poor if measured based on an unselected real-world population of patients. Still, the majority of German aNSCLC patients do not receive a mutation test.

中文翻译：

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晚期非小细胞肺癌患者的真实治疗和生存：德国回顾性数据分析

这项研究的目的是描述诊断为晚期非小细胞肺癌（aNSCLC）的德国患者的真实治疗和总生存（OS），并探讨与真实死亡风险相关的因素。这是德国对aNSCLC事件的回顾性索赔数据分析。数据有效期为2011年1月1日至2016年12月31日。鉴定合格患者的时间为2012年1月1日至2015年12月31日，以允许至少1年的预索引和随访期。观察了aNSCLC诊断后的住院和门诊突变测试程序。此外，对所有患者和假定的EGFR / ALK / ROS-1阳性患者均描述了自首次（发生）aNSCLC诊断和开始各自治疗线以来的处方治疗和OS。在多变量Cox回归分析中分析了与OS相关的因素。总体上，观察到1741名aNSCLC患者（平均年龄：66·97岁，女性：29·87％）。该人群的突变检测率为26·31％（n = 458），其中这些患者的26·6％（n = 122）接受了靶向治疗，并假设其EGFR / ALK / ROS-1检测结果为阳性。处方药最常使用的是培美曲塞单一疗法1 L（所有患者为21·23％，突变阳性患者为11·11％），厄洛替尼单一疗法为2 L（25·83％/ 38·54％）。自事件诊断以来，OS的中位数为351天，突变阳性患者为571天。在多变量Cox回归分析中，年龄较高，IV期疾病，自从首次诊断为aNSCLC以来，在索引期之前有更多的慢性药物出现，并且没有全身疗法会增加早期死亡的风险。另一方面，女性和采用化学疗法以外的治疗方法与较低的早期死亡风险相关。尽管引入了新的治疗方法，但如果根据未选择的真实患者群体进行测量，aNSCLC患者的真实生存预后仍然很差。尽管如此，大多数德国aNSCLC患者仍未接受突变测试。