Ding Jerry W, Hussein Abdulkadir A, Huang Zhong Ren, Ehsan Kamran, Moudgil Devinder, Kulkarni Swati
Medical Oncology, Windsor Regional Hospital Cancer Program, Windsor, CAN.
Medicine, Schulich School of Medicine & Dentistry, Windsor, CAN.
Cureus. 2022 Apr 29;14(4):e24605. doi: 10.7759/cureus.24605. eCollection 2022 Apr.
The impact of diagnosis and treatment delay on outcomes in advanced non-small cell lung carcinoma (NSCLC) is not well understood. In this study, we examined the effect of the length of time to the first chemotherapy treatment initiation and the other factors affecting overall survival.
This retrospective study used data from the Institute of Clinical Evaluative Sciences and identified 4520 patients in Ontario who were diagnosed with stage IV NSCLC between 2007 and 2016, treated using chemotherapy. We adjusted the analysis for location (rural vs urban), gender, distance from the nearest cancer center, first chemotherapy treatment used, income, and age. Results: Type of the chemotherapy, length of time to the first treatment, and distance from the nearest cancer center had a statistically significant impact on survival. Paclitaxel was associated with decreased risk of death compared to vinorelbine (Hazard Ratio (HR)=0.835, 95%CI 0.753-0.925), gemcitabine (HR=0.916, 95%CI 0.998-0.826), and docetaxel (HR=0.771, 95%CI 0.994-0.513). Every additional 10 km distance from the nearest cancer center was associated with a 0.5% increased risk of death (HR=1.005, 95%CI 1.000-1.010). A longer time to the first treatment was associated with increased survival. In fact, every 10 days increase in wait time was associated with a 0.5% decrease in the risk of death (HR=0.995, 95%CI 0.993-0.998). Conclusion: Chemotherapy treatment using paclitaxel and living closer to the cancer center is associated with better survival. A longer time between diagnosis and treatment leading to better survival could perhaps be explained by patients on the "sicker" end of the spectrum receiving treatment sooner.
诊断和治疗延迟对晚期非小细胞肺癌（NSCLC）预后的影响尚未得到充分了解。在本研究中，我们探讨了首次化疗开始时间的长短以及其他影响总生存期的因素。
这项回顾性研究使用了临床评估科学研究所的数据，确定了安大略省2007年至2016年间被诊断为IV期NSCLC并接受化疗的4520名患者。我们对地点（农村与城市）、性别、距最近癌症中心的距离、首次使用的化疗方案、收入和年龄进行了分析调整。结果：化疗类型、首次治疗时间长短以及距最近癌症中心的距离对生存期有统计学显著影响。与长春瑞滨相比，紫杉醇与死亡风险降低相关（风险比（HR）=0.835，95%置信区间0.753 - 0.925），与吉西他滨相比（HR = 0.916，95%置信区间0.998 - 0.826），与多西他赛相比（HR = 0.771，95%置信区间0.994 - 0.513）。距最近癌症中心每增加10公里，死亡风险增加0.5%（HR = 1.005，95%置信区间1.000 - 1.010）。首次治疗时间越长，生存期越长。事实上，等待时间每增加10天，死亡风险降低0.5%（HR = 0.995，9%置信区间0.993 - 0.998）。结论：使用紫杉醇进行化疗以及居住在离癌症中心较近的地方与更好的生存期相关。诊断和治疗之间时间较长导致更好的生存期，这可能是因为处于病情“较重”一端的患者更早接受了治疗。
