Kerekes Daniel M, Frey Alexander E, Bakkila Baylee F, Johnson Caroline H, Becher Robert D, Billingsley Kevin G, Khan Sajid A
Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
Yale School of Medicine, New Haven, CT, USA.
J Gastrointest Oncol. 2023 Apr 29;14(2):833-848. doi: 10.21037/jgo-22-1067. Epub 2023 Apr 17.
Initiation of oncologic care is often delayed, yet little is known about delays in hepatopancreatobiliary (HPB) cancers or their impact. This retrospective cohort study describes trends in time to treatment initiation (TTI), assesses the association between TTI and survival, and identifies predictors of TTI in HPB cancers.
The National Cancer Database was queried for patients with cancers of the pancreas, liver, and bile ducts between 2004 and 2017. Kaplan-Meier survival analysis and Cox regression were used to investigate the association between TTI and overall survival for each cancer type and stage. Multivariable regression identified factors associated with longer TTI.
Of 318,931 patients with HPB cancers, median TTI was 31 days. Longer TTI was associated with increased mortality in patients with stages I-III extrahepatic bile duct (EHBD) cancer and stages I-II pancreatic adenocarcinoma. Patients treated within 3-30, 31-60, and 61-90 days had median survivals of 51.5, 34.9, and 25.4 months (log-rank P<0.001), respectively, for stage I EHBD cancer, and 18.8, 16.6, and 15.2 months for stage I pancreatic cancer, respectively (P<0.001). Factors associated with increased TTI included stage I disease (+13.7 days stage IV, P<0.001), treatment with radiation only (β=+13.9 days, P<0.001), Black race (+4.6 days, P<0.001) and Hispanic ethnicity (+4.3 days, P<0.001).
Some HPB cancer patients with longer time to definitive care experienced higher mortality than patients treated expeditiously, particularly in non-metastatic EHBD cancer. Black and Hispanic patients are at risk for delayed treatment. Further research into these associations is needed.
肿瘤治疗的启动常常延迟，但关于肝胰胆（HPB）癌的延迟情况及其影响知之甚少。这项回顾性队列研究描述了开始治疗时间（TTI）的趋势，评估了TTI与生存率之间的关联，并确定了HPB癌患者TTI的预测因素。
查询国家癌症数据库中2004年至2017年间患有胰腺癌、肝癌和胆管癌的患者。采用Kaplan-Meier生存分析和Cox回归研究每种癌症类型和分期的TTI与总生存率之间的关联。多变量回归确定了与较长TTI相关的因素。
在318,931例HPB癌患者中，中位TTI为31天。在I - III期肝外胆管（EHBD）癌和I - II期胰腺腺癌患者中，较长的TTI与死亡率增加相关。I期EHBD癌患者在3 - 30天、31 - 60天和61 - 90天内接受治疗的中位生存期分别为51.5个月、34.9个月和25.4个月（对数秩检验P<0.001），I期胰腺癌患者分别为18.8个月、16.6个月和15.2个月（P<0.001）。与TTI增加相关的因素包括I期疾病（比IV期多13.7天，P<0.001）、仅接受放疗（β = +13.9天，P<0.001）、黑人种族（多4.6天，P<0.001）和西班牙裔种族（多4.3天，P<0.001）。
一些接受确定性治疗时间较长的HPB癌患者比迅速接受治疗的患者死亡率更高，尤其是在非转移性EHBD癌中。黑人和西班牙裔患者存在治疗延迟的风险。需要对这些关联进行进一步研究。
