以治愈为目的的老年非小细胞肺癌患者的治疗方法和预后因素的前瞻性多中心分析

BJR open Pub Date : 2022-01-01 DOI:10.1259/bjro.20210058
Jon Cacicedo, Francisco Casquero, Arturo Navarro, Lorea Martinez-Indart, Olga Del Hoyo, Andere Frías, Roberto Ortiz de Zarate, David Büchser, Alfonso Gómez-Iturriaga, Iñigo San Miguel, Fernan Suarez, Adrian Barcena, Jose Luis López-Guerra
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引用次数: 2

摘要

目的:分析老年局部晚期非小细胞肺癌(NSCLC)临床常规治疗中常用的以治愈为目的的治疗模式及总生存期的预测因素。方法:这项多中心前瞻性研究纳入了2014年2月至2018年1月期间诊断为NSCLC的年龄≥65岁的连续患者。纳入标准:年龄≥65岁,IIIA/IIIB期NSCLC。治疗决定由一个多学科委员会作出。Kaplan-Meier曲线和log-rank检验用于确定哪些临床/治疗相关变量,或考虑EORTC QLQ-C30(和LC13模块)的治疗前生活质量(QOL)可预测总生存期。结果:共纳入139例患者。中位随访时间为9.9个月(1.18-57.36个月),中位生存期为14个月(11-17个月)。在>75岁的患者中,委员会推荐化疗和序贯放疗(55.6%)或单独放疗(22.2%),而不是手术(3.7%)或同时放化疗(16.5%)。然而,在65- 75岁的患者中,有一半的病例推荐手术和联合放化疗(p=0.003)。多因素分析显示,存在心脏病(p=0.002)、身体功能评分低(p=0.0001)、有吞咽困难症状(p= 0.01)、胸痛(p=0.001)和未接受手术治疗(p=0.024)的患者死亡风险较高。结论:75岁以上患者多采用保守治疗。手术可提高生存率,无论患者年龄大小,均应慎重考虑。合并症和较差的基线生活质量预示着较短的生存期。知识的进步:在治疗前测量这些参数可以帮助我们确定预后较差的虚弱患者群体,以促进临床实践中的决策。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Prospective multicentre analysis of the therapeutic approach and prognostic factors determining overall survival in elderly patients with non-small-cell lung carcinoma treated with curative intent.

Prospective multicentre analysis of the therapeutic approach and prognostic factors determining overall survival in elderly patients with non-small-cell lung carcinoma treated with curative intent.

Prospective multicentre analysis of the therapeutic approach and prognostic factors determining overall survival in elderly patients with non-small-cell lung carcinoma treated with curative intent.

Objective: To analyse patterns of treatment with curative intent commonly used in elderly patients with locally advanced non-small-cell lung carcinoma (NSCLC) and predictive factors of overall survival in routine clinical practice.

Methods: This multicentre prospective study included consecutive patients aged ≥65 years old diagnosed with NSCLC between February 2014 and January 2018. Inclusion criteria: age ≥65 years, stage IIIA/IIIB NSCLC. Treatment decisions were taken by a multidisciplinary committee. Kaplan-Meier curves and log-rank test were used to identify which clinical/treatment-associated variables, or pre-treatment quality of life (QOL) considering EORTC QLQ-C30 (and LC13 module) were predictive of overall survival.

Results: A total of 139 patients were recruited. Median follow-up was 9.9 months (1.18-57.36 months) with a median survival of 14 months (range 11-17 months). In the group>75-year-old patients, the committee recommended chemotherapy and sequential radiotherapy (55.6%) or radiotherapy alone (22.2%), rather than surgery (3.7%) or concomitant radiochemotherapy (16.5%). However, in 65- to 75-year-old patients, surgery and concomitant radiochemotherapy were recommended in half of cases (p=0.003). Regarding multivariate analysis, the risk of death was higher in patients with pre-existing heart disease (p=0.002), low score for physical functioning (p=0.0001), symptoms of dysphagia (p=0,01), chest pain (p=0.001), and those not undergoing surgical treatment (p=0.024).

Conclusions: Patients >75 years received more conservative treatments. Surgery improved survival and should be carefully considered, regardless of patient age. Comorbidities and poor baseline QOL are predictive of shorter survival.

Advances in knowledge: Measuring these parameters before treatment may help us to define a population of frail patients with a poorer prognosis to facilitate decision making in clinical practice.

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