辅助化疗的NSCLC患者的早期死亡率

Background: Although adjuvant chemotherapy improves survival in patients with completely resected non-small-cell lung cancer (NSCLC), it is also associated with potentially disabling or lethal adverse events. Since there is limited information on the early mortality among patients undergoing adjuvant chemotherapy, we used the National Cancer Data Base (NCDB) to calculate the percentage of deaths within the first 6 months from starting chemotherapy. Methods: The NCDB was queried for patients aged 18 or older who were diagnosed with stage IB to IIIA NSCLC between 2004 and 2012 and received multi-agent adjuvant chemotherapy starting within 120 days from the surgical resection with negative surgical margins. Age groups were divided into less than 50, 51-60, 61-70, 71-80 and more than 80 years. Results: A total of 19,691 patients met the eligibility criteria, of which 19,398 had a known 6-month mortality status. The median age was 65 years (range 19-89). The 1, 2, 3, 4, 5 and 6-month cumulative mortality rates from initiation of chemotherapy were 0.7%, 1.3%, 1.9%, 2.6%, 3.3% and 4.2% respectively. The 6-month mortality rates for each age group (≤ 50 years, 51-60, 61-70, 71-80, and >80) was 2.6%, 3.1%, 4.1%, 5.3% and 7.6% respectively (p<0.001). Independent factors associated with increased 6-month mortality included age (age 71-80 vs < 50: odds ratio (OR) 1.72, 95% CI 1.16-2.55, p = 0.007, age > 80 vs < 50: OR 2.43; 1.40-4.20, p = 0.002), male gender (OR 1.42; 1.21-1.67, p <0.001), Charlson-Deyo comorbidity score (score 2 vs 0: OR 1.52; CI 1.22-1.89, p < 0.001), type of surgery (pneumonectomy OR 1.38, 1.11-1.73, p=0.004), length of stay after surgery > 6 days (OR 1.21; 1.03-1.41, p = 0.02) and readmission within 30 days from surgery (OR 1.48; 1.15-1.90, p = 0.02). Conclusion: Early mortality with the use of adjuvant chemotherapy following complete resection of NSCLC is a clinical concern. The risk is higher in patients older than 70 years, with higher co-morbidity scores and a prolonged length of stay post-operatively.

背景：

尽管辅助化疗可改善完全切除的非小细胞肺癌（NSCLC）患者的生存，但也与潜在致残或致命性不良事件有关。由于接受辅助化疗患者的早期死亡率信息有限，因此我们使用国立癌症数据库（NCDB）计算化疗开始后6个月内的死亡百分比。

方法：

查询NCDB中年龄≥18岁、2004年至2012年期间确诊的ⅠB-ⅢA期NSCLC、在切缘阴性的手术切除后120天内开始接受多药辅助化疗的患者。年龄组分为＜50、51-60、61-70、71-80和＞80岁。

结果：

共有19 691名患者符合入选标准，其中19 398例已知6个月的死亡率情况。中位年龄是65岁（范围19-89）。化疗开始后1、2、3、4、5和6个月的累积死亡率分别为0.7％、1.3％、1.9％、2.6％、3.3％和4.2％。每个年龄组的6个月死亡率（≤50岁、51-60、61-70、71-80和>80岁）分别为2.6％、3.1％、4.1％、5.3％和7.6％（p <0.001）。与6个月死亡率增加相关的独立因素包括年龄（年龄71-80对<50：比值比（OR）1.72，95%CI 1.16-2.55，p = 0.007，年龄>80对＜50：OR 2.43；1.40-4.20，p = 0.002），男性性别（OR 1.42；1.21-1.67，p <0.001），Charlson-Deyo合并症评分（2分对0分：OR 1.52；CI 1.22-1.89，p＜0.001），手术类型（肺切除术OR 1.38，1.11-1.73，p = 0.004），术后住院时间>6天（OR 1.21；1.03-1.41，p = 0.02），术后30天内再次入院（OR 1.48；1.15-1.90，p = 0.02）。

结论：

在NSCLC完全切除后使用辅助化疗的早期死亡率是临床担心的一个问题。70岁以上患者的风险较高，合并症发病率评分较高，术后住院时间延长。