Lung cancer survival in England: trends in non-small-cell lung cancer survival over the duration of the National Lung Cancer Audit.
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ABSTRACT: Background
In comparison with other European and North American countries, England has poor survival figures for lung cancer. Our aim was to evaluate the changes in survival since the introduction of the National Lung Cancer Audit (NLCA).Methods
We used data from the NLCA to identify people with non-small-cell lung cancer (NSCLC) and stratified people according to their performance status (PS) and clinical stage. Using Cox regression, we calculated hazard ratios (HRs) for death according to the year of diagnosis from 2004/2005 to 2010; adjusted for patient features including age, sex and co-morbidity. We also assessed whether any changes in survival were explained by the changes in surgical resection rates or histological subtype.Results
In this cohort of 120,745 patients, the overall median survival did not change; but there was a 1% annual improvement in survival over the study period (adjusted HR 0.99, 95% confidence interval (CI) 0.98-0.99). Survival improvement was only seen in patients with good PS and early stage (adjusted HR 0.97, 95% CI 0.95-0.99) and this was partly accounted for by changes in resection rates.Conclusion
Survival has only improved for a limited group of people with NSCLC and increasing surgical resection rates appeared to explain some of this improvement.
SUBMITTER: Khakwani A
PROVIDER: S-EPMC3798968 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundSEGA is a rare, slow-growing CNS neoplasm that has historically been treated by surgical resection. However, the advent of a mammalian target of rapamycin complex-1 inhibitor, everolimus, has shown promising results in recent clinical trials. We sought to provide an analysis of epidemiological and survival risk factors in this rare tumor entity, while comparing trends in surgical management before and after introduction of everolimus in SEGAs.MethodsPatients with SEGA were queried from the National Cancer Database between 2004 and 2015. Standard statistical analysis was conducted to assess variables associated with the odds of performing surgery and survival, while controlling for confounding variables.ResultsA total of 460 patients were diagnosed with SEGA. Multivariable analysis of survival demonstrated that increased age was associated with decreased survival (HR, 1.05; P < .0001). Multivariable analysis of surgery showed increased age (odds ratio [OR], 1.02, P = .04) and tumor size 20 mm or larger (OR, 9.52-16.75, P < .0001 for all) to be associated with higher odds of performing surgery. The use of radiotherapy (OR, 0.12, P = .008) or chemotherapy (OR, 0.21, P = .008) was associated with lower odds of surgery. A comparison of surgical rates between 2004 and 2010 and 2011 and 2015 was found to be significantly different, with a lower rate of surgery seen after 2011 (60.63% vs 48.06%, P = .007).ConclusionOur analysis of SEGAs demonstrated that age was the only variable affecting overall survival. Surgical resection was performed in older patients with larger tumors (> 20 mm) as a primary mode of treatment, without chemoradiotherapy. Expectedly, rates of surgical resection were found to have decreased since 2011, after FDA approval of everolimus for SEGA treatment.
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Project description:BACKGROUND:Preclinical studies suggest enhanced anti-tumor activity with combined radioimmunotherapy. We hypothesized that radiation (RT)?+?immunotherapy would associate with improved overall survival (OS) compared to immunotherapy or chemotherapy alone for patients with newly diagnosed metastatic non-small-cell lung cancer (NSCLC). METHODS:The National Cancer Database was queried for patients with stage IV NSCLC receiving chemotherapy or immunotherapy from 2013 to 2014. RT modality was classified as stereotactic radiotherapy (SRT) to intra- and/or extracranial sites or non-SRT external beam RT (EBRT). OS was analyzed using the Kaplan-Meier method and Cox proportional hazards models. RESULTS:In total, 44,498 patients were included (13% immunotherapy, 46.8% EBRT, and 4.7% SRT). On multivariate analysis, immunotherapy (hazard ratio [HR]:0.81, 95% confidence interval [CI]:0.78-0.83) and SRT (HR:0.78, 95%CI:0.70-0.78) independently associated with improved OS; however, the interaction term for SRT?+?immunotherapy was insignificant (p?=?0.89). For immunotherapy patients, the median OS for no RT, EBRT, and SRT was 14.5, 10.9, and 18.2?months, respectively (p?< 0.0001), and EBRT (HR:1.37, 95%CI:1.29-1.46) and SRT (HR:0.78, 95%CI:0.66-0.93) associated with OS on multivariate analysis. In the SRT subset, median OS for immunotherapy and chemotherapy was 18.2 and 14.3?months, respectively (p?=?0.004), with immunotherapy (HR:0.82, 95%CI:0.69-0.98) associating with OS on multivariate analysis. Furthermore, for patients receiving SRT, biologically effective dose (BED)?>?60?Gy was independently associated with improved OS (HR:0.79, 95%CI:0.70-0.90, p?< 0.0001) on multivariate analysis with a significant interaction between BED and systemic treatment (p?=?0.008). CONCLUSIONS:Treatment with SRT associated with improved OS for patients with metastatic NSCLC irrespective of systemic treatment. The high survival for patients receiving SRT?+?immunotherapy strongly argues for evaluation in randomized trials.
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