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. 2024 May 28:14:1382197.
doi: 10.3389/fonc.2024.1382197. eCollection 2024.

Three-year follow-up study reveals improved survival rate in NSCLC patients underwent guideline-concordant diagnosis and treatment

Huijuan Mu #  1   2 , Xing Yang #  1   3 , Yanxia Li  2 , Bingzheng Zhou  3   4 , Li Liu  1   2 , Minmin Zhang  1   3 , Qihao Wang  1   3 , Qian Chen  1   3 , Lingjun Yan  1   3 , Wei Sun  1   3 , Guowei Pan  1   3
Affiliations

Three-year follow-up study reveals improved survival rate in NSCLC patients underwent guideline-concordant diagnosis and treatment

Huijuan Mu et al. Front Oncol. .

Abstract

Background: No studies in China have assessed the guideline-concordance level of the first-course of non-small cell lung cancer (NSCLC) diagnosis and treatment and its relationship with survival. This study comprehensively assesses the current status of guideline-concordant diagnosis (GCD) and guideline-concordant treatment (GCT) of NSCLC in China and explores its impact on survival.

Methods: First course diagnosis and treatment data for NSCLC patients in Liaoning, China in 2017 and 2018 (n=1828) were used and classified by whether they underwent GCD and GCT according to Chinese Society of Clinical Oncology (CSCO) guidelines. Pearson's chi-squared test was used to determine unadjusted associations between categorical variables of interest. Logistic models were constructed to identify variables associated with GCD and GCT. Kaplan-Meier analysis and log-rank tests were used to estimate and compare 3-year survival rates. Multivariate Cox proportional risk models were constructed to assess the risk of cancer mortality associated with guideline-concordant diagnosis and treatment.

Results: Of the 1828 patients we studied, 48.1% underwent GCD, and 70.1% underwent GCT. The proportions of patients who underwent both GCD and GCT, GCD alone, GCT alone and neither GCD nor GCT were 36.7%, 11.4%, 33.5% and 18.4%, respectively. Patients in advanced stage and non-oncology hospitals were significantly less likely to undergo GCD and GCT. Compared with those who underwent neither GCD nor GCT, patients who underwent both GCD and GCT, GCD alone and GCT alone had 35.2%, 26.7% and 35.7% higher 3-year survival rates; the adjusted lung cancer mortality risk significantly decreased by 29% (adjusted hazard ratio[aHR], 0.71; 95% CI, 0.53-0.95), 29% (aHR, 0.71; 95% CI, 0.50-1.00) and 32% (aHR, 0.68; 95% CI, 0.51-0.90).

Conclusion: The 3-year risk of death is expected to be reduced by 29% if patients with NSCLC undergo both GCD and GCT. There is a need to establish an oncology diagnosis and treatment data management platform in China to monitor, evaluate, and promote the use of clinical practice guidelines in healthcare settings.

Keywords: diagnosis and treatment; first course; guideline-concordant; lung cancer; survival.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Case selection flowchart. NSCLC, non-small cell lung cancer.
Figure 2
Figure 2
Kaplan–Meier plot showing overall survival rate among patients underwent both GCD and GCT, GCD alone, GCT alone, or Neither.
Figure 3
Figure 3
Kaplan–Meier plot showing survival rate by clinical stage among patients underwent both GCD and GCT, GCD alone, GCT alone, or Neither.
See this image and copyright information in PMC

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