老年人在I期非小细胞肺癌手术或立体定向全身放射治疗后的长期依赖性

2022-08-30 14:39

与SBRT相比，手术提供了稳健的长期依赖性结果。这些是以患者为中心的重要终点，可用于 I 期 NSCLC 老年人的咨询和共同决策。

SCI

29 August 2022

_{Long-Term Dependency in Older Adults after Surgery or Stereotactic Body Radiation Therapy for Stage I Non-Small Cell Lung Cancer}

_{（IF: Ann. Surg., 4.339）}

Hirpara DH, Kidane B, Louie AV, Zuk V, Darling G, Rousseau M, Chesney T, Coburn N, Hallet J; REcovery after Surgical Therapy for Older adults REsearch – Cancer (RESTORE-C) group. Long-Term Dependency in Older Adults after Surgery or Stereotactic Body Radiation Therapy for Stage I Non-Small Cell Lung Cancer. Ann Surg. 2022 Aug 15.
Corresponding author:Julie Hallet, MD MSc FRCSC, 2075 Bayview avenue, Toronto, Ontario, Canada, M4N 3M5, T: 416-480-4774; F: 416-480-6002; E: Julie.hallet@suunbrook.ca

Objective 目的

To examine long-term healthcare dependency outcomes of SBRT to surgery for older adults with stage I non-small cell lung cancer (NSCLC).

研究SBRT对患有I期非小细胞肺癌（NSCLC）的老年人手术相关的长期医疗依赖性结果。

Summary Background Data 汇总背景数据

SBRT is an emerging alternative to surgery in patients with early stage lung cancer. There remains a paucity of prospective studies comparing these modalities, especially with respect to long-term dependency outcomes in older adults with lung cancer.

SBRT是早期肺癌患者手术的一种新兴替代方法。比较这些方式的前瞻性研究仍然很少，特别是在老年肺癌患者的长期依赖性结果方面。

Methods 方法

Adults >70 years old with stage I NSCLC treated with surgery or SBRT from January 2010-December 2017 were analyzed using 1:1 propensity score matching. Homecare use, days at home, and time spent alive and at home, were compared. E-value methods assessed residual confounding.

纳入了2010年1月至2017年12月期间接受手术或SBRT治疗的70岁以上I期非小细胞肺癌患者，采用1:1倾向评分匹配进行分析。比较了家庭护理的使用、在家的天数以及在世和在家中的生活时间。E值方法评估残余混杂。

Results 结果

A total of 1129 and 2570 patients underwent SBRT and surgery, respectively. 1,016 per group were matched. SBRT was associated with a higher overall risk of homecare utilization (HR 1.75, 95%CI 1.37, 2.23) than surgery, up to five years following treatment. While the hazards of death or nursing home admission were lower in the first 3 months after SBRT (HR 0.55, 95%CI 0.36-0.85), they became consistently higher beyond this period, and remained high up to five years compared to surgery (HR 2.13; 95%CI 1.85-2.45). The above findings persisted in stratified analyses for frail patients and those with no pre-treatment homecare. E-values indicated it was unlikely that the observed estimates could be explained by unmeasured confounders.

总共1129名和2570名患者分别接受了SBRT和手术。每组匹配1016人。SBRT与使用家庭护理的总风险（HR 1.75，95% CI, 1.37-2.23）在治疗后长达5年均高于手术。虽然在SBRT后的前3个月内死亡或入住养老院的风险较低（HR 0.55，95% CI, 0.36-0.85），但在这段时间之后，死亡或入住养老院的风险会持续升高，并且与手术相比在5年内保持较高水平（HR 2.13；95% CI, 1.85-2.45）。在对体弱患者和未接受治疗前家庭护理的患者的分层分析中，上述发现仍然存在。E值表明，观察到的估计值不太可能由未测量的混杂因素来解释。

Conclusions 结论

Surgery offers robust long-term dependency outcomes compared to SBRT. These are important patient-centred endpoints, which may be used for counselling and shared-decision making in older adults with stage I NSCLC.

与SBRT相比，手术提供了稳健的长期依赖性结果。这些是以患者为中心的重要终点，可用于 I 期 NSCLC 老年人的咨询和共同决策。