分期转换提高肺癌生存率：一个真实世界证据

SCI

8 Octember 2022

Stage Shift Improves Lung Cancer Survival: A Real-world Evidence

(Journal of Thoracic Oncology, IF: 20.12)

Ching-Yao Yang, Yen-Ting Lin, Li-Ju Lin, Ya-Hsuan Chang, Hsuan-Yu Chen, Yi-Pin Wang, Jin-Yuan Shih, Chong-Jen Yu, Pan-Chyr Yang

CORRESPONDENCE TO: pcyang@ntu.edu.tw

Introduction 导言

Lung cancer is the global leading cause of cancer death. Taiwan initiated several health policies including smoking cessation, precision therapy and low-dose computed tomography (LDCT) screening since 1997.Weaimed to investigate the impact of public policies on lung cancer survival.

肺癌是全球癌症死亡的主要原因。自1997年以来，台湾启动了多项健康政策，包括戒烟、精准治疗和低剂量计算机断层扫描（LDCT）。我们致力于调查公共政策对肺癌生存率的影响。

Methods 方法

We retrieved the nationwide cancer registry from Ministry of Health and Welfare to examine the smoking prevalence, lung cancer incidence and mortality from 1994 to 2020. We also conducted a retrospective analysis on clinical characteristics and survival on 17,298 lung cancer patients from 2006 to 2019usingNational Taiwan University Hospital (NTUH) database.

我们从卫生福利部检索全国癌症登记册，调查1994-2020年吸烟率、肺癌发病率和死亡率。我们还利用国立台湾大学医院（NTUH）数据库对2006年-2019年17298例肺癌患者的临床特征和生存率进行了回顾性分析。

Results 结果

Taiwan initiated an anti-smoking campaign in 1997, reimbursed tyrosine kinase inhibitors since 2004, and an LDCT screening trial in2015. The lung cancer incidence keeps rising; whereas, the annual percent change (APC) in mortality rate gradually decreased from 0.41% to -2.41%. The NTUH data revealed that 5-year survival substantially improved from 22.1% in 2006–2011 to 54.9% in 2015–2020. Improvement was observed in all stages, especially late stages (stage III: from 17.2% to 35.2%; stage IV: 7.9% to 16.5%). Furthermore, a remarkable shift of cancer stage was observed (stage 0/I/II increased from 19.3% to 62.8%, stage III/IV decreased from 70.9% to 33.8%). The prominent survival improvement was primarily driven by the stage shift from advanced to localized potentially curable disease.

台湾于1997年发起了禁烟运动，自2004年开始报销酪氨酸激酶抑制剂，并于2015年进行了LDCT筛查试验。肺癌发病率持续上升；然而，死亡率的年百分比变化（APC）从0.41%逐渐下降到2.41%。国立台湾大学医院的数据显示，5年生存率从2006年至2011年的22.1%大幅提高至2015年至2020年的54.9%。所有分期患者的数据都有改善，尤其是晚期阶段（III期：从17.2%提高至35.2%；IV期：7.9%提高至16.5%）。此外，观察到癌症分期发生了显著变化（0/I/II期从19.3%增加到62.8%，III/IV期从70.9%减少到33.8%）。显著的生存率改善主要是由晚期疾病向局部潜在可治愈疾病的分期转变所致。

Conclusions 结论

This real-world evidence suggested an association between improved survival and LDCT screening and diagnostic shift from late to early stage of lung cancer, highlighting the importance of early detection for lung cancer control.

这一真实世界证据表明，生存率的提高与LDCT筛查和肺癌诊断从晚期向早期转变之间存在关联，突出了早期检测对肺癌控制的重要性。