Teng Jun, Liu Yan, Xia Junyan, Luo Yi, Zou Heng, Wang Hongwu
Respiratory Disease Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, Beijing, China.
Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, Beijing, China.
Heliyon. 2023 Sep 2;9(9):e19750. doi: 10.1016/j.heliyon.2023.e19750. eCollection 2023 Sep.
Understanding the effects of a delayed time-to-treatment initiation(TTI) for non-small cell lung cancer (NSCLC) is vital.
We analyzed NSCLC data from the Surveillance, Epidemiology, and End Results database, focusing on lung adenocarcinoma (LUAD) and lung squamous carcinoma (LUSC). TTI was studied as both continuous and dichotomous variables. Restricted cubic splines were employed to identify potential nonlinear dependency between the hazard ratio (HR) and TTI. Propensity score matching was used to ensure a balanced patient allocation, and then survival differences between groups were assessed using Kaplan-Meier analysis and competing risk models. We used overall survival (OS) as the primary outcome and cancer-specific cumulative mortality (CSCM) as a complementary indicator. Finally, sensitivity analyses were performed on censored data.
A total of 80,020 with NSCLC were analyzed. TTI was assessed as a continuous variable, showing a noticeable increase in the HR for stage I to II NSCLC with TTI >1 month. Conversely, the trend for stage III to IV NSCLC was the opposite. In stage I LUAD, the 'early' group demonstrated a higher OS compared to the 'delayed' group (Log-rank = 0.002), while there was no significant difference in CSCM (Fine-gray = 0.321). In stage I LUSC, there was no significant difference in OS(Log-rank = 0.260), but the 'early' group had a lower CSCM (Fine-gray = 0.018). For stage II-IV NSCLC, the 'delayed' group did not exhibit a negative impact on OS or CSCM. The sensitivity analysis further supported the results of the main analysis.
Prolongation of TTI ≥31 days has a negative impact on OS or CSCM in stage I NSCLC only. Further exploration and validation are needed to determine whether these results can be used as evidence for a 'safe' TTI threshold setting for future NSCLC.
了解非小细胞肺癌（NSCLC）延迟治疗起始时间（TTI）的影响至关重要。
我们分析了监测、流行病学和最终结果数据库中的NSCLC数据，重点关注肺腺癌（LUAD）和肺鳞状细胞癌（LUSC）。TTI作为连续变量和二分变量进行研究。采用受限立方样条来识别风险比（HR）与TTI之间潜在的非线性依赖关系。使用倾向评分匹配来确保患者分配均衡，然后使用Kaplan-Meier分析和竞争风险模型评估组间生存差异。我们将总生存期（OS）作为主要结局，并将癌症特异性累积死亡率（CSCM）作为补充指标。最后，对删失数据进行敏感性分析。
共分析了80020例NSCLC患者。TTI作为连续变量进行评估时，对于I至II期NSCLC，TTI>1个月时HR显著升高。相反，III至IV期NSCLC的趋势则相反。在I期LUAD中，“早期”组的OS高于“延迟”组（对数秩检验=0.002），而CSCM无显著差异（Fine-gray检验=0.321）。在I期LUSC中，OS无显著差异（对数秩检验=0.260），但“早期”组的CSCM较低（Fine-gray检验=0.018）。对于II-IV期NSCLC，“延迟”组对OS或CSCM未表现出负面影响。敏感性分析进一步支持了主要分析的结果。
仅在I期NSCLC中，TTI延长≥31天对OS或CSCM有负面影响。需要进一步探索和验证，以确定这些结果是否可作为未来NSCLC“安全”TTI阈值设定的依据。
