筛查出肺癌的成人复发模式

IF 2.4 3区医学 Q3 ONCOLOGY

Cancer Epidemiology Pub Date : 2025-02-18 DOI:10.1016/j.canep.2025.102777

Nikki M. Carroll , Jennifer Eisenstein , Kris F. Wain , Jared M. Freml , Robert T. Greenlee , Stacey A. Honda , Christine Neslund-Dudas , Katharine A. Rendle , Anil Vachani , Debra P. Ritzwoller

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引用次数: 0

摘要

近年来，随着肺癌筛查（LCS）的引入，肺癌分期向早期疾病转移，但LCS是否影响了社区环境中的复发率和生存率，我们所知甚少。我们的目的是评估在接受LCS分层的复发肺癌的检测和结果的变化。方法选取2014年1月1日至2020年12月31日期间诊断为I-IIIA期非小细胞肺癌（NSCLC）的55-80岁患者，这些患者完成了最终治疗并被认为无疾病。复发率以离散的12个月间隔和累积发病率计算。通过多变量调整的限制平均生存时间（aRMST）评估生存期。用泊松模型评估与复发相关的因素。结果在916例符合研究标准的患者中，708例（77 %）未被筛查，208例（23 %）被筛查。未筛查检出的复发率（22 %）与筛查检出的复发率（17 %）相似（P = 0.11）。在最终治疗后的第一年和第二年，未筛查组的复发率分别为10.1 / 100人年和4.1 / 100人年，筛查组的复发率分别为6.0 / 100人年和4.5 / 100人年。未筛查组两年累积复发率为16.5 %(95 % CI, 13.9 %-19.4 %)，筛查组为13.8 %（95 % CI, 9.3 %-19.0 %）。两组无复发生存期和复发后生存期相似。筛查状态与复发可能性无关（RR=0.94, 95 % CI, 0.59-1.50）。结论这些发现提供了证据，证明复发是疾病进展的内在本质的一部分，尽管检测方式不同。我们的研究结果强调，无论采用何种检测方式，所有早期NSCLC患者在接受治疗后都需要接受监测和生存期护理。进一步的研究和更长的随访是必要的。

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Patterns of recurrence among adults diagnosed with screen-detected lung cancer

Background

With the recent shift in lung cancer staging towards early-stage disease coinciding with the introduction of lung cancer screening (LCS), little is known if LCS has affected the rate of recurrence and survival in community settings. Our objective was to evaluate variation in the detection and outcomes of recurrent lung cancer stratified by receipt of LCS.

Methods

Patients aged 55–80 years old diagnosed with stage I-IIIA non-small cell lung cancer (NSCLC) between 1/1/2014 and 12/31/2020 who completed definitive therapy and were considered disease-free were identified. Rates of recurrence were calculated in discrete 12-month intervals and by cumulative incidence. Survival was evaluated by multivariable adjusted Restricted Mean Survival Time (aRMST). Factors associated with recurrence were evaluated by Poisson models.

Results

Among 916 patients meeting study criteria, 708 (77 %) were non-screen-detected and 208 (23 %) were considered screen-detected. The proportion of recurrence between non-screen-detected (22 %) and screen-detected (17 %) was similar (P = 0.11). Recurrence rates during the first and second years after definitive therapy were 10.1 and 4.1 per 100 person-years for the non-screen-detected and 6.0 and 4.5 per 100 person-years for screen-detected, respectively. Two-year cumulative incidence of recurrence was 16.5 % (95 % CI, 13.9 %-19.4 %) for non-screen-detected patients and 13.8 % (95 % CI, 9.3 %-19.0 %) in the screen-detected group. Recurrence-free survival and survival after recurrence were similar between the two groups. Screening status was not associated with the likelihood of recurrence (RR=0.94, 95 % CI, 0.59–1.50).

Conclusion

These findings provide evidence of recurrence being a part of the intrinsic nature of disease progression despite mode of detection. Our findings emphasize the need for all patients to receive surveillance and survivorship care after treatment for early-stage NSCLC regardless of mode of detection. Further study with longer follow-up is warranted.

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来源期刊

Cancer Epidemiology 医学-肿瘤学

CiteScore

4.50

自引率

3.80%

发文量

200

审稿时长

39 days

期刊介绍： Cancer Epidemiology is dedicated to increasing understanding about cancer causes, prevention and control. The scope of the journal embraces all aspects of cancer epidemiology including: • Descriptive epidemiology • Studies of risk factors for disease initiation, development and prognosis • Screening and early detection • Prevention and control • Methodological issues The journal publishes original research articles (full length and short reports), systematic reviews and meta-analyses, editorials, commentaries and letters to the editor commenting on previously published research.