Department of Gynecologic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo NY, United States of America.
Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo NY, United States of America.
PLoS One. 2018 Nov 12;13(11):e0206913. doi: 10.1371/journal.pone.0206913. eCollection 2018.
We aimed to investigate the prognostic impact of duration of first-line chemotherapy administration in patients with epithelial ovarian cancer (EOC).
Chemotherapy records were abstracted from the electronic medical record. Patients with on-time completion (105 days) were compared to patients finishing early (<105 days), delays of 1-4 weeks, or >4 weeks. For 222 women with stage IIIC/IV, stage-stratified estimates of progression-free survival (PFS) and overall survival (OS) were compared. A delay sub-study was performed with outliers removed. Each week of delay was correlated with the change in PFS and OS to identify time points associated with change in outcome.
Most women had on-time completion of chemotherapy (23.6%) or a treatment delay of ≤4 weeks (21.8%); 21.6% of women experienced a delay longer than 4 weeks. R0 resection at initial debulking (OR = 1.99, 95%CI: 1.18-3.36, p = 0.010) and RECIST complete response (OR = 4.88, 95%CI: 2.47-10.63, p<0.001) were strongly associated with on-time completion. Patients with on-time completion and < 1 month delay had similar median survivals of 43.1 months (lower 95% CI bound 33.7 months) and 44.5 months (lower bound 37.0, p = 0.93). Women with >1 month delay had decreased median survival of 18.1 months (14.7-24.9 months), while women with short intervals survived 35.0 months (95%CI: 21.8-49.8 months). Short-term delays lead to progressively decreasing OS. This was significantly different from the on-schedule survival estimate after 6 weeks of delay.
On-time completion of chemotherapy correlates with increased survival and higher complete response rates. Increasing delays in chemotherapy completion were associated with decreased survival.
我们旨在研究上皮性卵巢癌（EOC）患者一线化疗给药时间的长短对预后的影响。
从电子病历中提取化疗记录。将按时完成（<105 天）的患者与提前完成（<105 天）、延迟 1-4 周和>4 周的患者进行比较。对于 222 名 IIIC/IV 期患者，对无进展生存期（PFS）和总生存期（OS）进行分层估计。对延迟亚研究进行了离群值剔除。比较每延迟一周与 PFS 和 OS 的变化，以确定与结果变化相关的时间点。
大多数女性按时完成化疗（23.6%）或延迟治疗≤4 周（21.8%）；21.6%的女性延迟时间超过 4 周。初次减瘤术时达到 R0 切除（OR=1.99，95%CI：1.18-3.36，p=0.010）和 RECIST 完全缓解（OR=4.88，95%CI：2.47-10.63，p<0.001）与按时完成治疗呈强相关。按时完成治疗且延迟时间<1 个月的患者中位生存期相似，分别为 43.1 个月（下限 95%CI 为 33.7 个月）和 44.5 个月（下限 37.0，p=0.93）。延迟>1 个月的患者中位生存期为 18.1 个月（14.7-24.9 个月），而短时间延迟的患者中位生存期为 35.0 个月（95%CI：21.8-49.8 个月）。短期延迟导致 OS 逐渐下降。这与 6 周后按时完成化疗的生存估计有显著差异。
按时完成化疗与生存增加和更高的完全缓解率相关。化疗完成时间的延迟增加与生存降低相关。
