PO.PS01.08 · 人群科学

在退伍军人事务（VA）医疗系统中转移性癌症美国退伍军人的新一代测序使用情况

Next-generation sequencing utilization among U.S. Veterans with metastatic cancer in the VA Healthcare System

编号 6290 展板 20 时间 4/21 02:00–05:00 区域 Section 34 主讲 John Bihn

分会场 Genetic Epidemiology 2: Pathway Analysis, Sequencing, Functional Genetics / Family and Hereditary Studies

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作者与单位 Authors & Affiliations

John R. Bihn¹, Aditi Hazra¹, Kaelyn Nannini¹, Cassidy Kenny², Rachel E. Ward¹, Jennifer La¹, Nathanael R. Fillmore¹, Gieira S. Jones², J. M. Gaziano¹

¹VA Boston Healthcare System, Boston, MA,²Merck and Co., Inc, Rahway, NJ

摘要 Abstract

中文摘要

背景：获得分子和基因检测使精准肿瘤学的实施和癌症预后的改善成为可能。然而，美国退伍军人中检测使用的模式仍研究不足。本研究评估了三种常见癌症的转移性患者接受 FoundationOne 新一代测序（NGS）检测的情况。我们评估了在全国范围内退伍军人事务（VA）医疗系统中检测的人口统计学、临床和健康的社会决定因素（SDOH）相关因素。方法：我们对 2019 至 2023 年间在 VA 系统中接受治疗、记录于 VA 癌症登记处的患有转移性肺癌、结直肠癌或前列腺癌的美国退伍军人进行了回顾性队列研究。我们通过国家精准肿瘤学项目（NPOP）数据库，按年份和癌症类型评估了 FoundationOne NGS 组套（CDx 和液体活检）的使用情况；在本研究期间，其他 NGS 平台超出了本研究的范围。使用描述性统计检验了检测频率与 SDOH（包括自我报告的种族、族裔、年龄、性别、乡村性和社会经济地位）的关联，标准均值差（SMD）>0.1 被视为显著。结果：在 71,569 名癌症患者中，17.4%（n = 12,465）患有转移性疾病。其中，4,743 名患者接受了 FoundationOne NGS 检测（38.1%），包括 514 名结直肠癌患者、2,519 名各种组织学类型的肺癌患者以及 1,710 名前列腺癌患者。接受检测的患者比未接受检测的患者更年轻（中位年龄 71.5 对 72.8，SMD = 0.26）。观察到种族分布的差异（SMD = 0.14）；例如，27.7% 的接受检测患者为黑人或非裔美国人，而未接受检测患者中这一比例为 22.4%。与未接受检测的患者相比，接受检测的患者更可能非衰弱（36.6% 对 31.8%），且不太可能严重衰弱（4.2% 对 6.0%，SMD = 0.15），而在性别（SMD = 0.053）或族裔（SMD = 0.04）方面未发现实质性差异。接受检测的结直肠癌（20.2% 对 24.7%，SMD = 0.11）和肺癌患者（29.3% 对 34.3%，SMD = 0.12）中乡村患者的比例低于未接受检测的患者；接受检测的患者在结直肠癌（中位 24.6 km 对 31.9 km，SMD = 0.13）和前列腺癌（25.6 km 对 32.1 km，SMD = 0.11）方面也居住在离 VA 设施更近的地方。结论：在患有常见转移性癌症的退伍军人中，我们发现某些人口统计学和临床因素在 FoundationOne NGS 检测使用上存在差异，而其他因素显示出相似的检测率。未来方向包括评估 VA 中使用的其他 NGS 平台，以及通过社区护理进行的 NGS 检测。持续投资于远程肿瘤学和有针对性外展等干预措施，可能有助于增加 NGS 检测，并确保所有退伍军人都能从精准癌症护理中获益。

查看英文原文 English abstract

Background: Access to molecular and genetic testing enables the delivery of precision oncology and improved cancer outcomes. However, patterns of testing utilization among U.S. Veterans remain understudied. This study evaluated the receipt of FoundationOne next-generation sequencing (NGS) testing for metastatic patients across three common cancers. We assessed demographic, clinical, and social determinants of health (SDOH) correlates of testing within the nationwide Veterans Affairs (VA) healthcare system. Methods: We conducted a retrospective cohort study of U.S. Veterans recorded in the VA Cancer Registry with metastatic lung, colorectal, or prostate cancer and treated in the VA system from 2019 - 2023. We evaluated the utilization of FoundationOne NGS panels (CDx and Liquid) by year and cancer type as accessed through the National Precision Oncology Program (NPOP) database; for this study period other NGS platforms were beyond the scope of this study. Associations of testing frequency with SDOH, including self-reported race, ethnicity, age, sex, rurality, and socioeconomic status, were examined using descriptive statistics, with standard mean differences (SMD) >0.1 considered significant. Results: Among 71,569 cancer patients, 17.4% (n = 12,465) had metastatic disease. Of these, 4,743 patients received FoundationOne NGS testing (38.1%) including 514 colorectal cancer patients, 2,519 lung cancer patients across histologies, and 1,710 prostate cancer patients. Tested patients were younger than non-tested patients (median age of 71.5 vs. 72.8, SMD = 0.26). Differences in racial distribution were observed (SMD = 0.14); for example, 27.7% of tested patients were Black or African American compared to 22.4% of non-tested patients. Tested patients were more likely to be non-frail (36.6% vs. 31.8%) and less likely to be severely frail (4.2% vs. 6.0%, SMD = 0.15) than non-tested patients, while no substantial disparities were found across sex (SMD = 0.053) or ethnicity (SMD = 0.04). The proportion of rural patients was lower for tested colorectal (20.2% vs. 24.7%, SMD = 0.11) and lung cancer patients (29.3 % vs. 34.3%, SMD = 0.12) versus non-tested patients; tested patients also resided closer to VA facilities for colorectal (median of 24.6 km vs. 31.9 km, SMD = 0.13) and prostate cancer (25.6 km vs. 32.1 km, SMD = 0.11). Conclusion: Among Veterans with common metastatic cancers, we identified differences in FoundationOne NGS testing utilization for some demographic and clinical factors, while other factors showed similar testing rates. Future directions include evaluating additional NGS platforms utilized in the VA, as well as NGS testing through community care. Continued investment in interventions such as tele-oncology and targeted outreach may help increase NGS testing and ensure all Veterans benefit from precision cancer care.

利益披露 Disclosure

J. R. Bihn, None.. A. Hazra, None.. K. Nannini, None. C. Kenny, Merck and Co., Inc Employment. R. E. Ward, None. J. La, Merck and Co., Inc ). Bayer AG ). N. R. Fillmore, Merck and Co., Inc ). Bayer AG ). G. S. Jones, Merck and Co., Inc. Employment, Stock. J. M. Gaziano, Merck and Co., Inc ).

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