■中国尚无研究评估非小细胞肺癌(NSCLC)第一疗程诊断和治疗的指南一致性水平及其与生存率的关系。本研究全面评估了中国非小细胞肺癌的指南一致诊断(GCD)和指南一致治疗(GCT)的现状,并探讨了其对生存的影响。
■辽宁省非小细胞肺癌患者的第一疗程诊断和治疗数据,根据中国临床肿瘤学会(CSCO)指南,中国在2017年和2018年(n=1828)使用并根据是否接受GCD和GCT进行分类。Pearson的卡方检验用于确定感兴趣的分类变量之间的未调整关联。构建Logistic模型以识别与GCD和GCT相关的变量。使用Kaplan-Meier分析和对数秩检验来估计和比较3年生存率。构建多变量Cox比例风险模型来评估与指南一致的诊断和治疗相关的癌症死亡风险。
■在我们研究的1828名患者中,48.1%接受了GCD,70.1%接受了GCT。同时接受GCD和GCT的患者比例,仅GCD,单独GCT和GCD和GCT均不占36.7%,11.4%,33.5%和18.4%,分别。晚期和非肿瘤医院的患者接受GCD和GCT的可能性明显较小。与未接受GCD和GCT的患者相比,同时接受GCD和GCT的患者,单独GCD和单独GCT占35.2%,3年生存率分别提高26.7%和35.7%;调整后的肺癌死亡风险显著降低29%(调整后的风险比[aHR],0.71;95%CI,0.53-0.95),29%(AHR,0.71;95%CI,0.50-1.00)和32%(aHR,0.68;95%CI,0.51-0.90)。
■如果NSCLC患者同时接受GCD和GCT治疗,预计3年死亡风险将降低29%。有必要在中国建立肿瘤诊疗数据管理平台,评估,并促进在医疗机构中使用临床实践指南。
UNASSIGNED: No studies in
China have assessed the guideline-concordance level of the first-course of non-small cell lung cancer (NSCLC) diagnosis and treatment and its relationship with survival. This study comprehensively assesses the current status of guideline-concordant diagnosis (GCD) and guideline-concordant treatment (GCT) of NSCLC in
China and explores its impact on survival.
UNASSIGNED: First course diagnosis and treatment data for NSCLC patients in Liaoning,
China in 2017 and 2018 (n=1828) were used and classified by whether they underwent GCD and GCT according to Chinese Society of Clinical Oncology (CSCO) guidelines. Pearson\'s chi-squared test was used to determine unadjusted associations between categorical variables of interest. Logistic models were constructed to identify variables associated with GCD and GCT. Kaplan-Meier analysis and log-rank tests were used to estimate and compare 3-year survival rates. Multivariate Cox proportional risk models were constructed to assess the risk of cancer mortality associated with guideline-concordant diagnosis and treatment.
UNASSIGNED: Of the 1828 patients we studied, 48.1% underwent GCD, and 70.1% underwent GCT. The proportions of patients who underwent both GCD and GCT, GCD alone, GCT alone and neither GCD nor GCT were 36.7%, 11.4%, 33.5% and 18.4%, respectively. Patients in advanced stage and non-oncology hospitals were significantly less likely to undergo GCD and GCT. Compared with those who underwent neither GCD nor GCT, patients who underwent both GCD and GCT, GCD alone and GCT alone had 35.2%, 26.7% and 35.7% higher 3-year survival rates; the adjusted lung cancer mortality risk significantly decreased by 29% (adjusted hazard ratio[aHR], 0.71; 95% CI, 0.53-0.95), 29% (aHR, 0.71; 95% CI, 0.50-1.00) and 32% (aHR, 0.68; 95% CI, 0.51-0.90).
UNASSIGNED: The 3-year risk of death is expected to be reduced by 29% if patients with NSCLC undergo both GCD and GCT. There is a need to establish an oncology diagnosis and treatment data management platform in
China to monitor, evaluate, and promote the use of clinical practice guidelines in healthcare settings.