How Much Delay Matters? How Time to Treatment Impacts Overall Survival in Early Stage Lung Cancer.

Autor:	Tang A; Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH., Ahmad U; Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH.; Taussig Cancer Center, Cleveland Clinic, Cleveland, OH., Raja S; Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH.; Taussig Cancer Center, Cleveland Clinic, Cleveland, OH., Bribriesco AC; Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH., Sudarshan M; Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH., Rappaport J; Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH., Khorana A; Taussig Cancer Center, Cleveland Clinic, Cleveland, OH., Blackstone EH; Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH.; Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH., Murthy SC; Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH.; Taussig Cancer Center, Cleveland Clinic, Cleveland, OH., Raymond DP; Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH.; Taussig Cancer Center, Cleveland Clinic, Cleveland, OH.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2023 Apr 01; Vol. 277 (4), pp. e941-e947. Date of Electronic Publication: 2021 Nov 18.
DOI:	10.1097/SLA.0000000000005307
Abstrakt:	Objectives: The aim of this study was to identify drivers of time from diagnosis to treatment (TTT) of surgically resected early stage non-small cell lung cancer (NSCLC) and determine the effect of TTT on post-resection survival. Summary Background Data: Large database studies that lack relevant comorbidity data have identified longer TTT asa driver of worse overall survival. Methods: From January 1, 2014 to April 1, 2018, 599 patients underwent lung resection for clinical stage I and II NSCLC. Random forest classification, regression, and survival were used to estimate likelihood of TTT = 0 (tissue diagnosis obtained at surgery), >0 (diagnosis obtained pre-resection), and effect of TTT on all-cause mortality. Results: Patients with TTT > 0 (n = 413) had median TTT of 42 days (25-75 th percentile: 27-59 days). Patients with TTT = 0 (n = 186) had smaller tumors and higher percent predicted forced expiratory volume in 1 second (FEV 1 %). Patients with history of stroke, oncology consultation, invasive mediastinal staging, low and high extremes of FEV 1 % had longer TTT. Higher clinical stage, lack of preoperative stress test, anemia, older age, lower FEV1% and diffusion lung capacity, larger tumor size, and longer TTT were the most important predictors of all-cause mortality. One- and 5-year overall survival decreased when TTT was >50 days. Conclusions: Preoperative physiologic workup and multidisciplinary evaluation were the predominant drivers of longer TTT. Patients with TTT = 0have more favorable presentation and should be considered in TTT analyses for early stage lung cancer populations. The time needed to clinically stage and optimize patients for resection is not deleterious to overall survival until resection is performed after 50 days from diagnosis. Competing Interests: The authors report no conflict of interests. (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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