晚期非小細胞肺癌診斷初期介入緩和性抗癌治療相對於治癒性抗癌治療或支持性治療的存活差異

Abstract

摘要 背景與目的 晚期非小細胞肺癌患者早期介入緩和性治療於標準腫瘤治療相較標準腫瘤治療，及緩和化療相較支持性治療能顯著延長存活期。過往研究較缺乏以族群為基礎釐清前述差異，因此，本研究運用全人口資料庫審視診斷初期介入緩和性抗癌治療相較治癒性抗癌治療或支持性治療之存活差異。 方法 本研究運用臺灣全人口癌症登記資料庫、健康保險資料庫及死因統計檔，回溯性分析西元2011至2015年間新診斷晚期非小細胞肺癌患者，診斷初期介入緩和性抗癌治療相較治癒性抗癌治療或支持性治療、及不同治療目的之化療與標靶之存活差異；使用卡方檢定及ANOVA檢定分析患者特徵差異，存活分析則使用Kaplan-Meier方法、Log-rank或Wilcoxon方法檢定存活差異並以Cox proportional hazard model評估各因子之風險比(Hazard Ratio)。 結果 晚期非小細胞肺癌患者15,342人，緩和組、治癒組、支持組之整體存活中位數分別為9、14、2個月(P<0.0001)，及1年存活率分別為21.94%、34.15%、1.96%，使用安寧照護比例於緩和組39.77%、治癒組32.38%；診斷後進入安寧時程中位數於緩和組187.5天、治癒組346天；首次抗癌治療日至最後抗癌治療日期間中位數於緩和組194天、治癒組319天。晚期緩和與治癒化療之整體存活中位數皆為10個月(P=0.0450)，於IIIB期約30個月前緩和化療傾向較治癒化療之存活情形略好；晚期緩和與治癒標靶之整體存活中位數分別為12、16個月(P=0.0843)，於IIIB期約13個月前緩和標靶傾向較治癒標靶之存活情形略好。 結論 晚期非小細胞肺癌患者診斷初期接受緩和性抗癌治療之存活情形顯著地較支持性治療好，且次族群治療效果也顯示抗癌治療方式會影響緩和性治療目的之效能；本研究結果也許能呈現診斷初期緩和性抗癌治療介入對存活情形有好處。

Abstract Background and purpose. Early palliative anticancer therapy used in patients with advanced non-small cell lung cancer can significantly prolong survival period, but lack of population-based clarification. Therefore, this study used the population-based database to examine the difference in survival between the initial interventional palliative anticancer therapy compared with curative anticancer therapy or supportive care. Methods. All patients newly diagnosed with advanced non-small cell lung cancer between 2011 and 2015 were obtained from Taiwan National Cancer Registry database, National Health Insurance database, and National Cause of Death Registry database. This population-based study compared the difference in survival of patients with early palliative anticancer therapy, curative anticancer therapy and supportive treatment. We also compared the survival of patients received chemotherapy and target therapy for different treatment purposes. Chi-square test and ANOVA test were used to analyze patients’ characteristics, and survival analysis was performed by using Kaplan-Meier method (Log-rank or Wilcoxon test) and Cox proportional hazard model. Results. Of 15,342 patients identified with advanced non-small cell lung cancer, the median survival of the palliative, curative, and support groups was 9, 14 and 2 months (P < 0.0001), and the 1-year survival rates were 21.94%, 34.15% and 1.96%, respectively. The proportion of using hospice care in the palliative group and curative group were 39.77%, and 32.38%, respectively. The median time of entering the hospice care after diagnosis was 187.5 days in the palliative group and 346 days in the curative group. The median duration between the first anticancer therapy day and the last anticancer therapy day was 194 days in the palliative group and 319 days in the curative group. The median overall survival of palliative and curative chemotherapy in advanced stage were both 10 months (P=0.0450). During the first 30 months with stage IIIB, the survival tendency to palliative chemotherapy was slightly better than that with curative chemotherapy. The overall survival of palliative and curative targeted therapy in advanced stage was 12 and 16 months (P=0.0843), respectively. During the first 13 months with stage IIIB, the survival tendency to palliative targeted therapy was slightly better than that with curative targeted therapy. Conclusions. The survival of advanced patients receiving palliative anticancer therapy at the diagnosis was significantly better than that receiving supportive therapy, and the subgroups treatment effect also showed that the kind of anticancer will affect the efficacy of palliative groups. This study may provide survival benefit of early palliative anticancer therapy.