Birmingham School of Medicine and O'Neal Comprehensive Cancer Center, University of Alabama, Birmingham, Alabama, USA.
University of New Mexico School of Medicine, New Mexico, USA.
Cancer Med. 2023 Feb;12(3):3488-3498. doi: 10.1002/cam4.5133. Epub 2022 Aug 17.
Given the dearth of data regarding the time to treatment initiation (TTI) in the palliative setting, and its impact on survival outcomes, we sought to determine TTI in a real-world cohort of metastatic colorectal cancer (mCRC) and metastatic pancreatic cancer (mPC) patients and evaluate the impact of TTI on real-world survival outcomes.
We collected survival and treatment data for mCRC and mPC from the Flatiron Health electronic health records (EHR) derived database. We divided TTI into 3 categories: < 2 weeks, 2-< 4 weeks, and 4-8 weeks, from diagnosis to first-line therapy. Outcome measures were median TTI, real-world overall survival (RW-OS) based on TTI categories by Kaplan-Meier method, and impact of TTI on survival using cox proportional hazard models.
Among 7108 and 3231 patients with mCRC and mPC treated within 8 weeks of diagnosis, the median TTI were 28 days and 20 days. Median RW-OS for mCRC was 24 months; 26.9 months versus 22.6 and 18.05 months in the 4-8-week, 2-< 4 week (control) and < 2-week groups, respectively (p < 0.0001). For mPC, median RW-OS was 8 months, without significant difference in RW-OS among the groups (p = 0.05). The 4-8-week group was associated with lower hazard of death (HR 0.782, 95% CI 0.73-0.84, p < 0.0001) and the < 2-week group was associated with a higher hazard of death (HR 1.26, 95% CI 1.15-1.38, p < 0.0001) in mCRC. The 4-8-week group was associated with lower hazard of death for mPC (HR 0.88, 95% CI 0.8-0.97, p = 0.0094).
In a real-world cohort of patients treated within 8 weeks of diagnosis, and with the limitations of a retrospective study, later TTI did not have a negative impact on survival outcomes in mCRC and mPC.
鉴于姑息治疗中治疗开始时间（TTI）的数据稀缺及其对生存结果的影响，我们试图确定转移性结直肠癌（mCRC）和转移性胰腺导管腺癌（mPC）患者真实世界队列中的 TTI，并评估 TTI 对真实世界生存结果的影响。
我们从 Flatiron Health 电子病历（EHR）衍生数据库中收集 mCRC 和 mPC 的生存和治疗数据。我们将 TTI 分为 3 类：<2 周、2-<4 周和 4-8 周，从诊断到一线治疗。结局指标包括 TTI 的中位数、按 TTI 类别计算的真实世界总生存（RW-OS），以及通过 Cox 比例风险模型评估 TTI 对生存的影响。
在 7108 例和 3231 例 mCRC 和 mPC 患者中，在诊断后 8 周内接受治疗，TTI 的中位数分别为 28 天和 20 天。mCRC 的中位 RW-OS 为 24 个月；4-8 周、2-<4 周（对照组）和<2 周组分别为 26.9 个月、22.6 个月和 18.05 个月（p<0.0001）。对于 mPC，中位 RW-OS 为 8 个月，各组间 RW-OS 无显著差异（p=0.05）。4-8 周组的死亡风险较低（HR 0.782，95%CI 0.73-0.84，p<0.0001），<2 周组的死亡风险较高（HR 1.26，95%CI 1.15-1.38，p<0.0001）。4-8 周组 mPC 的死亡风险较低（HR 0.88，95%CI 0.8-0.97，p=0.0094）。
在诊断后 8 周内接受治疗的真实世界队列患者中，且由于这是一项回顾性研究，较晚的 TTI 并未对 mCRC 和 mPC 的生存结果产生负面影响。
