What's the magic number? Impact of time to initiation of treatment for rectal cancer.
What's the magic number? Impact of time to initiation of treatment for rectal cancer.
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DOI：
10.1016/j.surg.2021.08.032
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发表时间：
2022-05
期刊：
影响因子：
3.8
通讯作者：
Hawkins AT
中科院分区：
文献类型：
--
作者：
Edwards GC;Gamboa AC;Feng MP;Muldoon RL;Hopkins MB;Abdel-Misih S;Balch GC;Holder-Murray J;Mohammed M;Regenbogen SE;Silviera ML;Hawkins AT
包括国家直肠癌认证计划在内的国家指南建议在诊断后 60 天内开始直肠癌治疗，但及时开始治疗对肿瘤结果的影响尚不清楚。本研究的目的是评估诊断后 60 天内开始直肠癌治疗对肿瘤学结果的影响。这是使用美国直肠癌联盟（由六个学术医疗中心合作组成）对 2/3 期直肠癌患者进行的回顾性评价。纳入2010年1月1日至2018年12月31日期间接受根治性切除的临床2/3期直肠癌患者。主要暴露是诊断后 60 天内开始治疗，定义为切除或开始化疗或放化疗。主要结局是疾病复发，次要结局是全因死亡率。共有 1,031 名符合纳入标准的患者被纳入分析。 830 名患者（80.5%）在诊断后 60 天内开始治疗，201 名患者（20.3%）在诊断后 60 天后开始治疗。在多变量逻辑回归中，年龄较大、非白人种族和居住地距离治疗中心超过 100 英里与治疗延迟超过 60 天显着相关。在生存分析中，167 名患者（16.2%）出现疾病复发，127 名患者（12.3%）因任何原因死亡。在考虑了病理分期、治疗顺序、就诊距离、年龄、合并症、治疗中心和接受辅助化疗的调整模型中，无进展生存期和全因死亡率与及时开始治疗均无显着相关性，风险比分别为 1.09 (0.70, 1.69) 和 1.03 (0.63, 1.66)。这项研究发现，开始治疗超过 60 天后，肿瘤学结果没有差异。
National guidelines, including the National Accreditation Program for Rectal Cancer, recommend initiation of rectal cancer treatment within 60 days of diagnosis, however the effect of timely treatment initiation on oncologic outcomes is unclear. The purpose of this study was to evaluate the impact on oncologic outcomes of initiation of rectal cancer treatment within 60 days of diagnosis. This was a retrospective review of stage 2/3 rectal cancer patients performed using the US Rectal Cancer Consortium, a collaboration of six academic medical centers. Patients with clinical stage 2/3 rectal cancer who underwent radical resection between January 1, 2010 and December 31, 2018 were included. The primary exposure was treatment initiation, defined as either resection or initiation of chemotherapy or chemoradiotherapy, within 60 days of diagnosis. The primary outcome was disease recurrence and the secondary outcome was all-cause mortality. A total of 1,031 patients meeting inclusion criteria were included in the analysis. Treatment was initiated within 60 days of diagnosis in 830 patients (80.5%) and after 60 days in 201 patients (20.3%). In multivariable logistic regression, older age, non-White race and residence greater than 100 miles from the treatment center were significantly associated with delay in treatment beyond 60 days. In survival analysis, 167 patients (16.2%) experienced recurrent disease and 127 patients (12.3%) died of any cause. In an adjusted model accounting for pathologic staging, treatment sequence, distance to care, age, comorbidities, treatment center, and receipt of adjuvant chemotherapy, neither progression-free survival nor all-cause mortality was significantly associated with timely initiation of therapy with hazard ratios of 1.09 (0.70, 1.69) and 1.03 (0.63, 1.66), respectively. This study found no difference in oncologic outcomes with initiation of treatment beyond 60 days.
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影响因子：
158.5
作者：
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通讯作者：
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作者：
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