The Effects of Time to Treatment Initiation for Patients With Non-small-cell Lung Cancer in the United States.

Autor: Cushman TR; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX., Jones B; Department of Radiation Oncology, University of Colorado School of Medicine, Denver, CO., Akhavan D; Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA., Rusthoven CG; Department of Radiation Oncology, University of Colorado School of Medicine, Denver, CO., Verma V; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX., Salgia R; Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA., Sedrak M; Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA., Massarelli E; Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA., Welsh JW; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX., Amini A; Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA. Electronic address: aamini@coh.org.
Jazyk: angličtina
Zdroj: Clinical lung cancer [Clin Lung Cancer] 2021 Jan; Vol. 22 (1), pp. e84-e97. Date of Electronic Publication: 2020 Sep 18.
DOI: 10.1016/j.cllc.2020.09.004
Abstrakt: Background: The purpose of this study was to determine the effects of time from diagnosis to treatment (TTI) on survival in patients with nonmetastatic non-small-cell lung cancer (NSCLC).
Materials and Methods: The National Cancer Database was queried for patients with stages 1 to 3 NSCLC between 2004 and 2013. Patients with missing survival status/time, unknown TTI, or receipt of palliative therapy were excluded. Multivariable Cox proportional hazards modeling, logistic regression, and recursive partitioning analysis were performed to determine associated variables and survival outcomes.
Results: Altogether, 1,393,232 patients met inclusion criteria. The median follow-up was 36 months. The median TTI increased between 2004 and 2013 from 35 to 39 days (P < .001). On multivariable Cox proportional hazards modeling, TTI groups 31 to 60 days, 61 to 90 days, and > 90 days were independently related to poorer overall survival (OS) compared with TTI 1 to 30 days (hazard ratio, 1.04, 1.10, and 1.14; 95% confidence interval [CI], 1.02-1.06, 1.07-1.12, and 1.11-1.17, respectively; P < .001 for all). Recursive partitioning analysis revealed that TTI of ≤ 45 days was the most optimal threshold for survival (P < .001); patients with TTI ≤ 45 days had a median OS of 70.2 months (95% CI, 69.3-71.1 months) versus 61.5 months (95% CI, 60.5-62.4) (P < .001). There were significant disparities by age, race, ethnicity, and income for delayed (> 45 days) TTI (P < .001 for all). Subgroup analysis revealed that stage 1 and 2 patients with TTI > 45 days had a higher risk of mortality compared with TTI ≤ 45 days (hazard ratio, 1.15 and 1.05; 95% CI, 1.12-1.17 and 1.01-1.09, respectively) (P < .001).
Conclusions: Increased TTI is independently associated with poorer survival in non-metastatic NSCLC. TTI ≤ 45 days is a clinically targetable time frame associated with improved outcomes and ought to be considered for patients with lung cancer undergoing definitive therapy.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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