背景
COVID-19 疫情對全 病人於 COVID-19 疫情期間之長期影響與治療變化研究仍有限，特別是在疫情爆發時間相對較晚的背景下。
方法
本研究為單中心回溯性世代研究，使用台灣中部某醫院 2017 至 2022 年真實世界資料，共納入 997 名 NSCLC 病人，其中 122 人曾確診 COVID-19。感染辨識透過 ICD-10-CM 診斷碼、抗病毒藥物、實驗室結果及出院紀錄關鍵字進行。以 COVID-19 為結果變項，利用 Boruta 與 LASSO 篩選混雜因子，並採用逆機率加權（IPW）進行調整。主要結果為整體存活，透過 Kaplan–Meier 與 Cox 模型評估；另以 TTNT 作為疾病進展替代指標，並進行競爭風險分析，同時比較疫情前後醫療模式與治療延遲。
結果
經 IPW 調整後，COVID-19 與非 COVID-19 組一年整體存活率無顯著差異（log-rank P = 0.91），時間相依 Cox 模型亦未顯示死亡風險增加（HR 0.97；95% CI 0.44–2.15；P = 0.947）。第四期接受標靶治療者中，COVID-19 組有較早更換治療之趨勢但未達顯著。整體醫療模式與治療等待時間維持穩定；疫情後門診頻率下降但未影響存活，居家醫療則增加。多數病人於疫情爆發前已完成疫苗接種。
結論
在台灣情境下，COVID-19 感染未對 NSCLC 病人之存活或治療連續性造成顯著影響，可能與公共衛生政策、延後爆發時程及醫療體系韌性有關。未來仍需長期追蹤與多中心研究加以驗證。

Background:
The COVID-19 pandemic has significantly affected healthcare systems and vulnerable populations, including cancer patients. Lung cancer, particularly non-small cell lung cancer (NSCLC), remains a leading cause of cancer-related mortality in Taiwan. However, few studies have investigated the long-term impact of COVID-19 on lung cancer patients, especially in regions like Taiwan, where the outbreak occurred relatively late.
Methods:
This single-center retrospective cohort study utilized real-world data from the hospital in central Taiwan, covering the years 2017 to 2022. A total of 997 NSCLC patients were analyzed, of whom 122 had confirmed COVID-19. COVID-19 infection was identified through ICD-10-CM five-character diagnostic codes, antiviral drug administration, laboratory test results, and keyword searches in discharge records.
First, COVID-19 infection served as the outcome, and machine learning methods, including Boruta and LASSO regression, were applied to identify potential confounding factors. These factors were then weighted using inverse probability weighting to minimize bias. Subsequently, death was used as the primary outcome, and survival analysis was conducted to evaluate the impact of COVID-19 on lung cancer patients. Kaplan-Meier survival curves and Cox proportional hazards models, adjusted for the selected confounders, were employed to assess overall survival.
In addition, time to next treatment (TTNT) was assessed as a proxy for cancer progression using Kaplan–Meier and competing risks analysis. Changes in medical practice and treatment delays were also examined across pandemic time periods.
Results:
After IPW, no significant difference was found in one-year overall survival between the COVID-19 and non-COVID-19 groups [median OS not reached in either group; log-rank P = 0.91]. Time-dependent Cox regression similarly showed no significant increase in mortality risk associated with COVID-19 [HR, 0.97; 95% CI, 0.44-2.15, P = 0.947]. Among stage IV patients receiving targeted therapy, the COVID-19 group exhibited a non-significant trend toward earlier treatment change [median OS not reached in either group; P = 0.39], which may be explained by higher early mortality. Medical practice, including treatment combinations and waiting time for therapy, remained stable before and after the pandemic emerged. While outpatient visit frequency declined after the outbreak, no negative impact on survival was observed. Homecare visits increased, possibly reflecting adaptive measures to protect high-risk patients. Limited vaccination data indicated that most patients were vaccinated before the Taiwan outbreak.
Conclusion:
Despite concerns regarding the vulnerability of lung cancer patients to COVID-19, this study found no significant adverse impact of COVID-19 exposure on survival or treatment continuity among NSCLC patients in Taiwan. The findings suggest that Taiwan’s proactive public health strategies, delayed outbreak timing, and a resilient healthcare system helped mitigate the pandemic’s effects. Continued follow-up is needed to assess long-term outcomes.

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