Timing of adjuvant chemotherapy initiation after surgery for stage III colon cancer
Timing of adjuvant chemotherapy initiation after surgery for stage III colon cancer
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DOI：
10.1002/cncr.22316
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发表时间：
2006-12-01
期刊：
影响因子：
6.2
通讯作者：
Neugut, Alfred I.
中科院分区：
文献类型：
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作者：
Hershman, Dawn;Hall, Michael J.;Neugut, Alfred I.
背景。肿瘤内科的一项重要进展是使用辅助化疗治疗淋巴结阳性结肠癌。然而，据作者所知，手术和开始化疗之间的时间间隔对生存率的影响尚未得到研究。方法。作者利用监测、流行病学和最终结果 (SEER)-医疗保险数据，分析了 1992 年至 1999 年间被诊断为 III 期结肠癌的 65 岁以上患者术后治疗时间间隔的预测因素和结果。使用线性和逻辑回归分析来模拟延迟的预测因素，并使用Cox比例风险模型来分析治疗时机对生存的影响。 结果。 4382例结肠癌患者中，1122例患者（26%）在1个月内开始辅助化疗，2391例患者（55%）在1~2个月内开始辅助化疗，454例患者（10%）在2~3个月内开始辅助化疗，415例患者（9%）在术后≥3个月开始辅助化疗。间隔 >= 3 个月（延迟）与年龄较大、合并症增加、分化程度良好/中等和未婚有关。结肠癌特异性死亡率与化疗开始延迟（风险比 [HR]，1.48；95% 置信区间 [95% CI]，1.15-1.92）、高龄、合并症增加、肿瘤分级差、存在 >= 4 个阳性淋巴结以及在非正规医院接受手术相关。与< 1个月相比，全因死亡率与手术和化疗之间的间隔> 2个月相关（2至3个月：HR，1.41；95% CI，1.15-1.74；>= 3个月：HR，1.62；95% CI，1.31-1.99）。结论。在所研究的老年人群中，只有 9% 的患者在根治性手术日期后 3 个月以上开始辅助化疗。然而，延迟启动与癌症特异性死亡率和全因死亡率相关。确定这些结果是否是由于化疗时机或其他相关因素造成的，需要进一步研究。
BACKGROUND. An important advance in medical oncology has been the use of adjuvant chemotherapy for lymph node-positive colon cancer. However, to the authors' knowledge, the effect of the interval between surgery and the initiation of chemotherapy on survival has not been investigated.METHODS. The authors analyzed predictors and outcomes of time intervals to treatment after surgery among patients older than 65 years who were diagnosed with stage III colon cancer between 1992 and 1999 using Surveillance, Epidemiology, and End Results (SEER)-Medicare data. Linear and logistic regression analyses were used to model predictors of delay, and Cox proportional hazards models were used to analyze the impact of treatment timing on survival.RESULTS. Among 4382 patients with colon cancer, 1122 patients (26%) began adjuvant chemotherapy within I month, 2391 patients (55%) began adjuvant chemotherapy in I to 2 months, 454 patients (10%) began adjuvant chemotherapy in 2 to 3 months, and 415 patients (9%) began adjuvant chemotherapy >= 3 months after surgery. Intervals of >= 3 months (delay) were associated with older age, increased comorbid conditions, well/moderately differentiated grade, and being unmarried. Colon cancer-specific mortality was associated with a delay in the initiation of chemotherapy (hazards ratio [HR], 1.48; 95% confidence interval [95% CI], 1.15-1.92), advanced age, increased comorbidity, poorly differentiated tumor grade, the presence of >= 4 positive lymph nodes, and undergoing surgery in a nomeaching hospital. All-cause mortality was associated with intervals > 2 months between surgery and chemotherapy (2 to 3 months: HR, 1.41; 95% CI, 1.15-1.74; >= 3 months: HR, 1.62; 95% CI, 1.31-1.99) compared with < 1 month.CONCLUSIONS. In the older population that was studied, only 9% of patients initiated adjuvant chemotherapy >= 3 months after the date of curative surgery. However, delay in initiation was associated with both cancer-specific and all-cause mortality. Determining whether these results were because of chemotherapy timing or other associated factors will require further study.