Clinical impact of prolonged diagnosis to treatment interval (DTI) among patients with oropharyngeal squamous cell carcinoma.
Clinical impact of prolonged diagnosis to treatment interval (DTI) among patients with oropharyngeal squamous cell carcinoma.
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延长诊断到治疗间隔（DTI）对口咽鳞状细胞癌患者的临床影响。
DOI：
10.1016/j.oraloncology.2016.02.010
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发表时间：
2016
期刊：
影响因子：
4.8
通讯作者：
Swisher-McClure,Samuel
中科院分区：
文献类型：
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作者：
Sharma,Sonam;Bekelman,Justin;Lin,Alexander;Lukens,JNicholas;Roman,BenjaminR;Mitra,Nandita;Swisher-McClure,Samuel
目的/目的(S)我们利用美国国家癌症数据库(NCDB)研究了口腔鳞状细胞癌放化疗患者中延长诊断至治疗间隔(DTI)和生存结局的危险因素。方法和资料2003年至2006年，我们确定了6606例III-IV期口咽鳞状细胞癌患者接受化疗。我们使用单变量和多变量Logistic回归模型确定了DTI延长(30天)的危险因素。我们使用Kaplan Meier和多变量COX比例风险模型对总生存期(OS)进行了检验。种族、调强放射治疗、保险状况和大容量设施是延长DTI的重要危险因素。与⩽相比，DTI延长的患者在30天内OS较差(危险比(HR)=1.12，95%CI为1.04~1.20，P=0.005)。DTI每增加一周，死亡风险就增加2.2%(95%可信区间1.1-3.3%，p<；0.001)。接受调强放疗、在学术机构或高容量设施接受治疗的患者更有可能经历延长的DTI(高容量与低容量：61.5%比51.8%，调整后OR 1.38，95%可信区间1.21-1.58；学术与社区：59.5%比50.6%，调整后OR 1.26，95%可信区间1.13-1.42；非调强放疗与调强放疗：53.4%比56.5%；调整后的OR1.17，95%可信区间1.04-1.31)。我们观察了社会经济因素在DTI中的差异。然而，学术背景、高容量和调强放射治疗等设施水平因素也增加了DTI的风险。在开发有效的途径以减轻长时间DTI的不良影响时，应考虑这些发现。
Purpose/objective(s)We examined practice patterns using the National Cancer Data Base (NCDB) to determine risk factors for prolonged diagnosis to treatment interval (DTI) and survival outcomes in patients receiving chemoradiation for oropharyngeal squamous cell carcinoma (OPSCC).Methods and materialsWe identified 6606 NCDB patients with Stage III–IV OPSCC receiving chemoradiation from 2003 to 2006. We determined risk factors for prolonged DTI (>30 days) using univariate and multivariable logistic regression models. We examined overall survival (OS) using Kaplan Meier and multivariable Cox proportional hazards models.Results3586 (54.3%) patients had prolonged DTI. Race, IMRT, insurance status, and high volume facilities were significant risk factors for prolonged DTI. Patients with prolonged DTI had inferior OS compared to DTI ⩽ 30 days (Hazard Ratio (HR) = 1.12, 95% CI 1.04–1.20,p= 0.005). For every week increase in DTI there was a 2.2% (95% CI 1.1–3.3%,p< 0.001) increase in risk of death. Patients receiving IMRT, treatment at academic, or high-volume facilities were more likely to experience prolonged DTI (High vs. Low volume: 61.5% vs. 51.8%, adjusted OR 1.38, 95% CI 1.21–1.58; Academic vs. Community: 59.5% vs. 50.6%, adjusted OR 1.26, 95% CI 1.13–1.42; non-IMRT vs. IMRT: 53.4% vs. 56.5%; adjusted OR 1.17, 95% CI 1.04–1.31).ConclusionsOur results suggest that prolonged DTI has a significant impact on survival outcomes. We observed disparities in DTI by socioeconomic factors. However, facility level factors such as academic affiliation, high volume, and IMRT also increased risk of DTI. These findings should be considered in developing efficient pathways to mitigate adverse effects of prolonged DTI.
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DOI：
10.1002/hed.10038
发表时间：
2002-02-01
影响因子：
2.9
作者：
Rosenthal, DI;Liu, L;Machtay, M
通讯作者：
Machtay, M
对于老年头颈癌患者，调强放射治疗与传统放射治疗相关的护理模式和结果。
DOI：
--
发表时间：
2012
期刊：
International Journal of Radiation Oncology, Biology, Physics
影响因子：
--
作者：
James B. Yu;P. Soulos;Richa Sharma;D. Makarov;R. Decker;Benjamin D. Smith;R. Desai;L. Cramer;C. Gross
通讯作者：
C. Gross
影响因子：
45.3
作者：
Bilimoria, Karl Y.;Bentrem, David J.;Ko, Clifford Y.
通讯作者：
Ko, Clifford Y.
DOI：
10.1056/nejmoa0912217
发表时间：
2010-07-01
期刊：
The New England journal of medicine
影响因子：
--
作者：
Ang KK;Harris J;Wheeler R;Weber R;Rosenthal DI;Nguyen-Tân PF;Westra WH;Chung CH;Jordan RC;Lu C;Kim H;Axelrod R;Silverman CC;Redmond KP;Gillison ML
通讯作者：
Gillison ML
影响因子：
5.7
作者：
Waaijer, A;Terhaard, CHJ;Lagendijk, JJW
通讯作者：
Lagendijk, JJW