Hershman Dawn, Hall Michael J, Wang Xiaoyan, Jacobson Judith S, McBride Russell, Grann Victor R, Neugut Alfred I
Department of Medicine, Mailman School of Public Health, Columbia University, New York, New York, USA.
Cancer. 2006 Dec 1;107(11):2581-8. doi: 10.1002/cncr.22316.
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.
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.
Among 4382 patients with colon cancer, 1122 patients (26%) began adjuvant chemotherapy within 1 month, 2391 patients (55%) began adjuvant chemotherapy in 1 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 nonteaching 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.
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.
医学肿瘤学的一项重要进展是对淋巴结阳性结肠癌使用辅助化疗。然而，据作者所知，手术与化疗开始之间的间隔时间对生存率的影响尚未得到研究。
作者使用监测、流行病学和最终结果（SEER）-医疗保险数据，分析了1992年至1999年间诊断为III期结肠癌的65岁以上患者手术后至治疗的时间间隔的预测因素和结果。使用线性和逻辑回归分析来建立延迟的预测模型，并使用Cox比例风险模型来分析治疗时机对生存率的影响。
在4382例结肠癌患者中，1122例（26%）在1个月内开始辅助化疗，2391例（55%）在1至2个月内开始辅助化疗，454例（10%）在2至3个月内开始辅助化疗，415例（9%）在手术后≥3个月开始辅助化疗。≥3个月（延迟）的间隔与年龄较大、合并症增加、高/中分化级别以及未婚有关。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、肿瘤分化差、≥4个阳性淋巴结以及在非教学医院接受手术有关。与<1个月相比，全因死亡率与手术和化疗之间间隔>2个月（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）有关。
在所研究的老年人群中，只有9%的患者在根治性手术后>3个月开始辅助化疗。然而，开始延迟与癌症特异性死亡率和全因死亡率均有关。确定这些结果是由于化疗时机还是其他相关因素需要进一步研究。
