美国国家癌症研究所Nadia Howlader团队分析了肺癌治疗进展对人群死亡率的影响。该研究发表在2020年8月13日的《新英格兰医学杂志》上。

肺癌由不同的亚型组成，包括非小细胞肺癌（NSCLC）和小细胞肺癌（SCLC）。虽然美国的肺癌总死亡率一直在下降，但由于死亡证明没有记录亚型信息，因此按癌症亚型划分的死亡率趋势鲜有人知。

研究组使用来自监视、流行病学和最终结果（SEER）区域的数据，对肺癌死亡率进行评估，并将肺癌死亡与SEER癌症注册表中的事件病例进行联系，从而评估归因于特定亚型的人群水平的死亡率趋势。

NSCLC的死亡率下降速度甚至快于该亚型的发病率，随着时间推移，这种下降与生存率大幅提高有关，且与批准靶向治疗的时间相对应。男性NSCLC基于发病率的死亡率在2013-2016年每年下降6.3％，而发病率在2008-2016年每年下降3.1％。相应的NSCLC男性肺癌特异性生存率从2001年的26％提高至2014年的35％。在所有种族和族裔群体中，生存率均有提高。在NSCLC女性中发现了相似模式。相比之下，SCLC由于发病率下降，其死亡率几乎整体下降，但生存率没有提高，该结果与研究组筛查时间范围内SCLC治疗进展有限有关。

总之，2013-2016年，美国NSCLC基于人口水平的死亡率急剧下降，确诊后的生存率大大提高。

附：英文原文

Title: The Effect of Advances in Lung-Cancer Treatment on Population Mortality

Author: Nadia Howlader, Ph.D.,, Gonalo Forjaz, D.V.M.,, Meghan J. Mooradian, M.D.,, Rafael Meza, Ph.D.,, Chung Yin Kong, Ph.D.,, Kathleen A. Cronin, Ph.D.,, Angela B. Mariotto, Ph.D.,, Douglas R. Lowy, M.D.,, and Eric J. Feuer, Ph.D.

Issue&Volume: 2020-08-12

Abstract: 

Background

Lung cancer is made up of distinct subtypes, including non–small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC). Although overall mortality from lung cancer has been declining in the United States, little is known about mortality trends according to cancer subtype at the population level because death certificates do not record subtype information.

Methods

Using data from Surveillance, Epidemiology, and End Results (SEER) areas, we assessed lung-cancer mortality and linked deaths from lung cancer to incident cases in SEER cancer registries. This allowed us to evaluate population-level mortality trends attributed to specific subtypes (incidence-based mortality). We also evaluated lung-cancer incidence and survival according to cancer subtype, sex, and calendar year. Joinpoint software was used to assess changes in incidence and trends in incidence-based mortality.

Results

Mortality from NSCLC decreased even faster than the incidence of this subtype, and this decrease was associated with a substantial improvement in survival over time that corresponded to the timing of approval of targeted therapy. Among men, incidence-based mortality from NSCLC decreased 6.3% annually from 2013 through 2016, whereas the incidence decreased 3.1% annually from 2008 through 2016. Corresponding lung cancer–specific survival improved from 26% among men with NSCLC that was diagnosed in 2001 to 35% among those in whom it was diagnosed in 2014. This improvement in survival was found across all races and ethnic groups. Similar patterns were found among women with NSCLC. In contrast, mortality from SCLC declined almost entirely as a result of declining incidence, with no improvement in survival. This result correlates with limited treatment advances for SCLC in the time frame we examined.

Conclusions

Population-level mortality from NSCLC in the United States fell sharply from 2013 to 2016, and survival after diagnosis improved substantially. Our analysis suggests that a reduction in incidence along with treatment advances — particularly approvals for and use of targeted therapies — is likely to explain the reduction in mortality observed during this period.

DOI: 10.1056/NEJMoa1916623

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1916623