Assessment of Time-to-Treatment Initiation and Survival in a Cohort of Patients With Common Cancers.
Assessment of Time-to-Treatment Initiation and Survival in a Cohort of Patients With Common Cancers.
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DOI：
10.1001/jamanetworkopen.2020.30072
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发表时间：
2020-12-01
影响因子：
13.8
通讯作者：
Trinh QD
中科院分区：
文献类型：
--
作者：
Cone EB;Marchese M;Paciotti M;Nguyen DD;Nabi J;Cole AP;Molina G;Molina RL;Minami CA;Mucci LA;Kibel AS;Trinh QD
在资源有限的环境和大流行的条件下，延迟开始治疗常见癌症与死亡率之间有什么联系？在这项包括2241706例乳腺癌、前列腺癌、非小细胞肺癌和结肠癌患者的队列研究中，一般而言，较高的全因死亡率与治疗时间增加相关，尽管程度因癌症类型和分期而异。结肠癌和肺癌患者的死亡率最高，与治疗时间延长相关。这些发现强调了及时治疗癌症的重要性，与目前流行病相关的指南相比，支持对中危和高危前列腺癌进行更及时的确定性治疗。本队列研究评估了乳腺癌、前列腺癌、非小细胞肺癌和结肠癌患者从诊断到治疗的时间与全因死亡率的关系。由于大流行或其他对基础设施的压力而造成的资源限制，需要对时间敏感的护理进行分类，包括癌症治疗。最佳治疗时间尚未充分探索，因此癌症治疗可以推迟的建议通常基于专家意见。评价美国4种最常见癌症的至确定性治疗时间延长与死亡率之间的相关性（作为癌症类型和分期的函数）。这项队列研究评估了2004年至2015年非转移性乳腺癌、前列腺癌、非小细胞肺癌（NSCLC）和结肠癌患者的治疗和结局信息，分析了2020年1月至3月的数据。从国家癌症数据库中收集了与适当的治愈性手术、放射或药物治疗相关的结局数据。治疗开始时间（TTI），诊断和治疗之间的间隔，使用8 - 60、61 - 120、121 - 180和大于180天的间隔。5-年和10年预测全因死亡率。该研究包括2241706例患者（平均[SD]年龄63 [11.9]岁，1 268 794 [56.6%]女性，1 880 317 [83.9%]白色）：乳腺癌1165585例（52.0%），前列腺癌853030例（38.1%），NSCLC 130597例（5.8%），结肠癌92494例（4.1%）。乳腺癌的中位（四分位距）TTI为32（21-48）天，前列腺癌为79（55-117）天，NSCLC为41（27-62）天，结肠癌为26（16-40）天。在所有癌症中，5年和10年预测死亡率的普遍增加与TTI的增加有关。最显著的死亡率关联是结肠癌（例如，5年预测死亡率，III期：TTI 61-120 d，38.9% vs. 181-365 d，47.8%），其次为I期NSCLC（5年预测死亡率：TTI 61-120 d，47.4% vs 181-365 d，47.6%），而前列腺癌的生存率最低（例如，5年预测死亡率，高风险：TTI 61-120 d，12.8% vs 181-365 d，14.1%），其次是乳腺癌（例如，5年预测死亡率，I期：TTI 61-120 d，11.0% vs 181-365 d，15.2%）。在II期肺癌患者中观察到治疗延迟和生存恶化的无显著性差异，无论治疗时间如何，II期肺癌患者的所有TTI的全因死亡率最高。在这项队列研究中，对于所有研究的癌症，有证据表明较短的TTI与较低的死亡率相关，这表明治疗延迟和死亡率之间的间接相关性可能多年来都不明显。与当前流行病相关指南相比，这些发现支持对中危和高危前列腺癌进行更及时的确定性治疗。
What is the association between delays in treatment initiation for common cancers, as are necessary in resource-limited settings and pandemic conditions, with mortality? In this cohort study including 2 241 706 patients with breast, prostate, non-small cell lung, and colon cancer, generally higher all-cause mortality was associated with increasing time to treatment, although the degree varied by cancer type and stage. Patients with colon and lung cancer had the highest mortality associated with increased time to treatment. These findings emphasize the importance of timely cancer treatment, and, in contrast to current pandemic-related guidelines, support more prompt definitive treatment for intermediate-risk and high-risk prostate cancer. This cohort study of patients with breast, prostate, non-small cell lung, and colon cancer assesses the association of time from diagnosis to treatment with all-cause mortality. Resource limitations because of pandemic or other stresses on infrastructure necessitate the triage of time-sensitive care, including cancer treatments. Optimal time to treatment is underexplored, so recommendations for which cancer treatments can be deferred are often based on expert opinion. To evaluate the association between increased time to definitive therapy and mortality as a function of cancer type and stage for the 4 most prevalent cancers in the US. This cohort study assessed treatment and outcome information from patients with nonmetastatic breast, prostate, non-small cell lung (NSCLC), and colon cancers from 2004 to 2015, with data analyzed January to March 2020. Data on outcomes associated with appropriate curative-intent surgical, radiation, or medical therapy were gathered from the National Cancer Database. Time-to-treatment initiation (TTI), the interval between diagnosis and therapy, using intervals of 8 to 60, 61 to 120, 121 to 180, and greater than 180 days. 5-year and 10-year predicted all-cause mortality. This study included 2 241 706 patients (mean [SD] age 63 [11.9] years, 1 268 794 [56.6%] women, 1 880 317 [83.9%] White): 1 165 585 (52.0%) with breast cancer, 853 030 (38.1%) with prostate cancer, 130 597 (5.8%) with NSCLC, and 92 494 (4.1%) with colon cancer. Median (interquartile range) TTI by cancer was 32 (21-48) days for breast, 79 (55-117) days for prostate, 41 (27-62) days for NSCLC, and 26 (16-40) days for colon. Across all cancers, a general increase in the 5-year and 10-year predicted mortality was associated with increasing TTI. The most pronounced mortality association was for colon cancer (eg, 5 y predicted mortality, stage III: TTI 61-120 d, 38.9% vs. 181-365 d, 47.8%), followed by stage I NSCLC (5 y predicted mortality: TTI 61-120 d, 47.4% vs 181-365 d, 47.6%), while survival for prostate cancer was least associated (eg, 5 y predicted mortality, high risk: TTI 61-120 d, 12.8% vs 181-365 d, 14.1%), followed by breast cancer (eg, 5 y predicted mortality, stage I: TTI 61-120 d, 11.0% vs. 181-365 d, 15.2%). A nonsignificant difference in treatment delays and worsened survival was observed for stage II lung cancer patients—who had the highest all-cause mortality for any TTI regardless of treatment timing. In this cohort study, for all studied cancers there was evidence that shorter TTI was associated with lower mortality, suggesting an indirect association between treatment deferral and mortality that may not become evident for years. In contrast to current pandemic-related guidelines, these findings support more timely definitive treatment for intermediate-risk and high-risk prostate cancer.
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影响因子：
3.7
作者：
Bilimoria KY;Stewart AK;Winchester DP;Ko CY
通讯作者：
Ko CY
影响因子：
9.6
作者：
Gould, Michael K.;Ghaus, Sharfun J.;Schultz, Ellen M.
通讯作者：
Schultz, Ellen M.
影响因子：
5.7
作者：
Gomez, Daniel R.;Liao, Kai-Ping;Smith, Benjamin D.
通讯作者：
Smith, Benjamin D.
影响因子：
45.3
作者：
McLaughlin, John M.;Anderson, Roger T.;Paskett, Electra D.
通讯作者：
Paskett, Electra D.
DOI：
10.1016/s0140-6736(17)32152-9
发表时间：
2017-09-16
期刊：
Lancet (London, England)
影响因子：
--
作者：
GBD 2016 Causes of Death Collaborators
通讯作者：
GBD 2016 Causes of Death Collaborators