Association of Delayed Adjuvant Chemotherapy With Survival After Lung Cancer Surgery
Association of Delayed Adjuvant Chemotherapy With Survival After Lung Cancer Surgery
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DOI：
10.1001/jamaoncol.2016.5829
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发表时间：
2017-05-01
期刊：
影响因子：
28.4
通讯作者：
Boffa, Daniel J.
中科院分区：
文献类型：
--
作者：
Salazar, Michelle C.;Rosen, Joshua E.;Boffa, Daniel J.
重要性辅助化疗为非小细胞肺癌的许多分期方案提供了生存益处。肺癌手术后的不同恢复期可能会延迟患者耐受辅助化疗的能力，但化疗启动的紧迫性尚不清楚。目的：根据非小细胞肺癌切除术和术后化疗启动之间的时间间隔，评估生存率的差异，以确定辅助治疗时机和疗效之间的关系。和参与者这项回顾性观察性研究检查了2004年1月至2012年12月期间在切除术后18至127天接受术后多药化疗的完全切除的非小细胞肺癌初治患者。研究人群仅限于淋巴结转移、肿瘤大于4 cm或局部扩散的患者。患者是从国家癌症数据库中确定的，该数据库是一个基于医院的肿瘤登记处，收集了美国70%以上的肺癌病例。采用限制性三次样条考克斯模型评价术后辅助化疗开始时间与生存率之间的关系。（中位[四分位距]年龄，64 [57-70]岁）：3073例患者（25%）为I期疾病; 5981例患者（48%）为II期; 3419例患者（27%）为III期。采用限制性三次样条的考克斯模型确定了术后50天开始化疗时的死亡风险最低（95% CI，39-56天）。在此间隔期（57-127天;即后一队列）后开始化疗并没有增加死亡率（风险比[HR]，1.037; 95% CI，0.972-1.105; P = 0.27）。此外，在一个包含3976个倾向匹配对的考克斯模型中，在晚期接受化疗的患者比仅接受手术治疗的患者的死亡风险更低（HR，0.664; 95%CI，0.623-0.707; P
IMPORTANCE Adjuvant chemotherapy offers a survival benefit to a number of staging scenarios in non-small-cell lung cancer. Variable recovery from lung cancer surgerymay delay a patient's ability to tolerate adjuvant chemotherapy, yet the urgency of chemotherapy initiation is unclear.OBJECTIVE To assess differences in survival according to the time interval between non-small-cell lung cancer resection and the initiation of postoperative chemotherapy to determine the association between adjuvant treatment timing and efficacy.DESIGN, SETTING, AND PARTICIPANTS This retrospective observational study examined treatment-naive patients with completely resected non-small-cell lung cancer who received postoperative multiagent chemotherapy between 18 and 127 days after resection between January 2004 and December 2012. The study population was limited to patients with lymph node metastases, tumors 4 cmor larger, or local extension. Patients were identified from the National Cancer Database, a hospital-based tumor registry that captures more than 70% of incident lung cancer cases in the United States. The association between time to initiation of adjuvant chemotherapy and survival was evaluated using Cox models with restricted cubic splines.EXPOSURES Adjuvant chemotherapy administered at different time points after surgery.MAIN OUTCOMES AND MEASURES Effectiveness of adjuvant chemotherapy according to time to initiation after surgery.RESULTS A total of 12 473 patients (median [interquartile range] age, 64 [57-70] years) were identified: 3073 patients (25%) with stage I disease; 5981 patients (48%), stage II; and 3419 patients (27%), stage III. A Cox model with restricted cubic splines identified the lowest mortality risk when chemotherapy was started 50 days postoperatively (95% CI, 39-56 days). Initiation of chemotherapy after this interval (57-127 days; ie, the later cohort) did not increase mortality (hazard ratio [HR], 1.037; 95% CI, 0.972-1.105; P =.27). Furthermore, in a Cox model of 3976 propensity-matched pairs, patients who received chemotherapy during the later interval had a lower mortality risk than those treated with surgery only (HR, 0.664; 95% CI, 0.623-0.707; P