质子束放疗在中枢神经系统肿瘤患者中的应用趋势：美国国家癌症数据库分析（2004—2021年）

doi:10.3760/cma.j.cn371439-20240624-00070

摘要/Abstract

摘要：

目的评估分析质子束放疗（PBT）在美国中枢神经系统（CNS）肿瘤患者中的使用趋势以及相关影响因素。方法利用美国国家癌症数据库查询2004－2021年CNS肿瘤患者的资料，根据患者的病理组织学类型、确诊年龄、保险状况、家庭收入水平、受教育水平、就诊医院类型等因素，探讨PBT在CNS肿瘤患者中的使用趋势。采用logistic多因素回归分析进行各种因素与PBT使用的相关性分析。结果共纳入192 696例CNS肿瘤患者，接受PBT治疗患者为5 901例（3.1%），其中年龄≥18岁患者4 109例（69.6%）。PBT在CNS肿瘤中的使用率从2004年的1.0%增加到2021年的11.4%。在接受PBT治疗的患者中，胚胎瘤是最常见的儿童肿瘤，而星形细胞瘤是最常见的成人肿瘤。logistic多因素回归分析显示，近年来胶质母细胞瘤、室管膜瘤、髓母细胞瘤、生殖细胞瘤患者采用PBT治疗较星形细胞瘤患者增长更迅速。年龄<18岁、无其他合并症、有私人保险、家庭收入水平较高和近年来确诊也与PBT的使用呈正相关。结论在美国，儿童及青少年患者、无其他合并症、家庭收入水平较高、有私人保险、近年来确诊和特定肿瘤组织学类型的患者更有可能接受PBT治疗。PBT的使用率从2004年的1.0%增加到2021年的11.4%。然而，应接受PBT的患者数量与实际接受PBT的患者数量之间仍存在明显差距。

关键词: 质子疗法, 中枢神经系统肿瘤, 美国国家癌症数据库

Abstract:

Objective To evaluate trends in the use of proton beam radiation therapy (PBT） in patients with central nervous system (CNS） tumors in the United States and the factors associated with such use. Methods The National Cancer Database was queried for CNS tumors patients between 2004 and 2021 to explore the time trend in the use of PBT by histology type， age at diagnosis， insurance， median household income level， education level， and hospital type. Multivariable logistic regression analysis was used to report the association of various factors with the use of PBT. Results Of all the 192 696 CNS patients， 5 901 （3.1%） received PBT， among whom 4 109 （69.6%） were ≥18 years of age. The use of PBT in CNS tumors increased from only 1.0% in 2004 to 11.4% in 2021. In patients who received PBT， embryonal tumor was the most common pediatric tumor while astrocytoma was most common adult tumor. Multivariable logistic regression analysis revealed that patients with glioblastoma， ependymoma， medulloblastoma， germinoma were more likely to received PBT compared to astrocytoma. Age<18 years， no-comorbidity， private insurance， higher household income level and being diagnosed in recent years were also positively associated with the use of PBT. Conclusion The patients with younger age， no-comorbidity， higher household income， private insurance， diagnosed in recent years and certain tumor histologists are more likely to receive PBT in the United States. The use of PBT increased from 1.0% in 2004 to 11.4% in 2021. However， there is still a distinguished gap between the number of patients who should receive PBT and the number of patients who received PBT.

Key words: Proton therapy, Central nervous system neoplasms, National Cancer Database

Saber Amin, Chi Lin. 质子束放疗在中枢神经系统肿瘤患者中的应用趋势：美国国家癌症数据库分析（2004—2021年）[J]. 国际肿瘤学杂志, 2024, 51(7): 424-431.

Saber Amin, Chi Lin. Trends of the use of proton beam radiation therapy in patients with central nervous system tumors： analysis of National Cancer Database (2004-2021）[J]. Journal of International Oncology, 2024, 51(7): 424-431.

图/表 6

表1

2004—2021年NCDB中CNS肿瘤患者的基线特征[例（%）]"

变量	PBT （n=5 901）	光子放疗（n=186 795）	合计（n=192 696）
确诊年龄（岁）
<18	1 792（30.4）	6 758（3.6）	8 550（4.4）
≥18	4 109（69.6）	180 037（96.4）	184 146（95.6）
性别
男	3 219（54.6）	98 108（52.5）	101 327（52.6）
女	2 682（45.4）	88 687（47.5）	91 369（47.4）
种族
白种人	5 010（84.9）	164 753（88.2）	169 763（88.1）
黑种人	446（7.6）	13 823（7.4）	14 269（7.4）
其他	445（7.5）	8 219（4.4）	8 664（4.5）
保险类型
私人保险	3 708（62.8）	94 448（50.6）	98 156（50.9）
医疗保险（≥65岁以及患有某些残疾的年轻人）	953（16.2）	16 111（8.6）	17 064（8.9）
医疗补助（低收入人群）	898（15.2）	64 186（34.4）	65 084（33.8）
其他政府类保险	126（2.1）	3 727（2.0）	3 853（2.0）
无保险/未知	216（3.7）	8 323（4.5）	8 539（4.4）
组织学类型
星形细胞瘤	1 558（26.4）	32 484（17.4）	34 042（17.7）
胶质母细胞瘤	1 252（21.2）	94 938（50.8）	96 190（49.9）
胚胎瘤	758（12.9）	2 297（1.2）	3 055（1.6）
室管膜瘤	571（9.7）	2 726（1.5）	3 297（1.7）
脑膜瘤	690（11.7）	28 583（15.3）	29 273（15.2）
髓母细胞瘤	304（5.2）	465（0.3）	769（0.4）
生殖细胞瘤	132（2.2）	480（0.3）	612（0.3）
神经鞘瘤	96（1.6）	16 617（8.9）	16 713（8.7）
其他	540（9.2）	8 205（4.4）	8 745（4.5）
社区家庭收入中位数（美元）
≤50 353	1 605（27.2）	66 312（35.5）	67 917（35.2）
>50 353	4 296（72.8）	120 483（64.5）	124 779（64.8）
社区教育水平（高中以下学历人口比例）
≥10.8%	2 195（37.2）	77 707（41.6）	79 902（41.5）
<10.8%	3 706（62.8）	109 088（58.4）	112 794（58.5）
Charlson-Deyo合并症指数
0	5 160（87.4）	146 421（78.4）	151 581（78.7）
1	489（8.3）	25 068（13.4）	25 557（13.3）
≥2	252（4.3）	15 306（8.2）	15 558（8.0）
确诊年份
2004—2013	1 005（17.0）	92 465（49.5）	93 470（48.5）
2014—2021	4 896（83.0）	94 330（50.5）	99 226（51.5）

表1

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表2

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