肺癌治疗指南致力于改善预后。理论上,彻底的分期促进最佳治疗选择。我们检查了指南与侵入性纵隔淋巴结分期之间的关系,指南-一致治疗,和非小细胞肺癌的生存率。
在结构化的多学科护理环境中,肺癌患者的侵入性纵隔淋巴结分期的当前做法是什么?指南一致分期与指南一致治疗是否相关?它们与生存率有何关系?
我们在浸信会癌症中心的多学科胸部肿瘤项目中评估了2014年至2019年诊断的非转移性非小细胞肺癌患者,孟菲斯,田纳西州。我们检查了纵隔淋巴结分期和分期分层治疗的模式,将患者分组为仅具有指南一致分期的队列,仅指南一致治疗,两者,或者都不是。我们用Kaplan-Meier曲线和Cox比例风险模型评估总生存期。
882名患者中,456(52%)接受了任何侵入性纵隔分期。74%的人接受了指南一致的分期;指南不一致的分期从2014年的34%下降到2019年的18%(P<0.0001)。指南一致分期的接受者更有可能接受指南一致治疗(83%vs66%;P<0.0001)。61%的患者同时接受了指南一致的侵入性纵隔分期和指南一致的治疗;13%的患者仅接受了指南一致的分期;17%的患者仅接受了指南一致的治疗;9%的患者均未接受。接受这两种治疗的患者的生存率最高(调整后的风险比[aHR],0.41;95%CI,0.26-0.63),其次是那些单独接受指南一致治疗的人(AHR,0.60;95%CI,0.36-0.99),和那些单独接受指南一致分期的人(AHR,0.64;95%CI,0.37-1.09)与两者均无比较(P<0.0001,对数秩检验)。
指南一致的分期水平很高,正在上升,并且在这个多学科治疗队列中与指南一致的治疗选择相关.指南一致的分期和指南一致的治疗在提高生存率方面是互补的。支持这两个过程和肺癌结局之间的联系。
Lung cancer management guidelines strive to improve outcomes. Theoretically, thorough staging promotes optimal treatment selection. We examined the association between guideline-concordant invasive mediastinal nodal staging, guideline-concordant treatment, and non-small cell lung cancer survival.
What is the current practice of invasive mediastinal nodal staging for patients with lung cancer in a structured multidisciplinary care environment? Is guideline-concordant staging associated with guideline-concordant treatment? How do they relate to survival?
We evaluated patients with nonmetastatic non-small cell lung cancer diagnosed from 2014 through 2019 in the Multidisciplinary Thoracic Oncology Program of the Baptist Cancer Center, Memphis, Tennessee. We examined patterns of mediastinal nodal staging and stage-stratified treatment, grouping patients into cohorts with guideline-concordant staging alone, guideline-concordant treatment alone, both, or neither. We evaluated overall survival with Kaplan-Meier curves and Cox proportional hazards models.
Of 882 patients, 456 (52%) received any invasive mediastinal staging. Seventy-four percent received guideline-concordant staging; guideline-discordant staging decreased from 34% in 2014 to 18% in 2019 (P < .0001). Recipients of guideline-concordant staging were more likely to receive guideline-concordant treatment (83% vs 66%; P < .0001). Sixty-one percent received both guideline-concordant invasive mediastinal staging and guideline-concordant treatment; 13% received guideline-concordant staging alone; 17% received guideline-concordant treatment alone; and 9% received neither. Survival was greatest in patients who received both (adjusted hazard ratio [aHR], 0.41; 95% CI, 0.26-0.63), followed by those who received guideline-concordant treatment alone (aHR, 0.60; 95% CI, 0.36-0.99), and those who received guideline-concordant staging alone (aHR, 0.64; 95% CI, 0.37-1.09) compared with neither (P < .0001, log-rank test).
Levels of guideline-concordant staging were high, were rising, and were associated with guideline-concordant treatment selection in this multidisciplinary care cohort. Guideline-concordant staging and guideline-concordant treatment were complementary in their association with improved survival, supporting the connection between these two processes and lung cancer outcomes.