Impact of time from diagnosis to chemotherapy in advanced gastric cancer: A Propensity Score Matching Study to Balance Prognostic Factors
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摘要
BACKGROUND It is unclear whether treatment delay affects the clinical outcomes of chemotherapy in advanced gastric cancer(A-GC).AIM To assess whether treatment delay affects the clinical outcomes of chemotherapy in A-GC.METHODS This single-center retrospective study examined consecutive patients with A-GC between April 2012 and July 2018. In total, 110 patients with stage Ⅳ A-GC who underwent chemotherapy were enrolled. We defined the wait time(WT) as the interval between diagnosis and chemotherapy initiation. We evaluated the influence of WT on overall survival(OS).RESULTS The mean OS was 303 d. The median WT was 17 d. We divided the patients into early and elective WT groups, with a 2-wk cutoff point. There were 46 and 64 patients in the early and elective WT groups, respectively. Compared with the elective WT group, the early WT group had significantly lower albumin(Alb)levels and higher neutrophil/lymphocyte ratios and C-reactive protein(CRP)levels but not a lower performance status. The elective WT group underwent more combination chemotherapy than did the early WT group. OS was different between the two groups(230 d vs 340 d, respectively). Multivariate analysis revealed that higher CRP levels, lower Alb levels and monotherapy were significantly related to a poor prognosis. To minimize potential selection bias,patients in the elective WT group were 1:1 propensity score matched with patients in the early WT group; no significant difference in OS was found(303 d vs 311 d, respectively, log-rank P = 0.9832).CONCLUSION A longer WT in patients with A-GC does not appear to be associated with a worse prognosis.
BACKGROUND It is unclear whether treatment delay affects the clinical outcomes of chemotherapy in advanced gastric cancer(A-GC).AIM To assess whether treatment delay affects the clinical outcomes of chemotherapy in A-GC.METHODS This single-center retrospective study examined consecutive patients with A-GC between April 2012 and July 2018. In total, 110 patients with stage Ⅳ A-GC who underwent chemotherapy were enrolled. We defined the wait time(WT) as the interval between diagnosis and chemotherapy initiation. We evaluated the influence of WT on overall survival(OS).RESULTS The mean OS was 303 d. The median WT was 17 d. We divided the patients into early and elective WT groups, with a 2-wk cutoff point. There were 46 and 64 patients in the early and elective WT groups, respectively. Compared with the elective WT group, the early WT group had significantly lower albumin(Alb)levels and higher neutrophil/lymphocyte ratios and C-reactive protein(CRP)levels but not a lower performance status. The elective WT group underwent more combination chemotherapy than did the early WT group. OS was different between the two groups(230 d vs 340 d, respectively). Multivariate analysis revealed that higher CRP levels, lower Alb levels and monotherapy were significantly related to a poor prognosis. To minimize potential selection bias,patients in the elective WT group were 1:1 propensity score matched with patients in the early WT group; no significant difference in OS was found(303 d vs 311 d, respectively, log-rank P = 0.9832).CONCLUSION A longer WT in patients with A-GC does not appear to be associated with a worse prognosis.
BACKGROUND It is unclear whether treatment delay affects the clinical outcomes of chemotherapy in advanced gastric cancer(A-GC).AIM To assess whether treatment delay affects the clinical outcomes of chemotherapy in A-GC.METHODS This single-center retrospective study examined consecutive patients with A-GC between April 2012 and July 2018. In total, 110 patients with stage Ⅳ A-GC who underwent chemotherapy were enrolled. We defined the wait time(WT) as the interval between diagnosis and chemotherapy initiation. We evaluated the influence of WT on overall survival(OS).RESULTS The mean OS was 303 d. The median WT was 17 d. We divided the patients into early and elective WT groups, with a 2-wk cutoff point. There were 46 and 64 patients in the early and elective WT groups, respectively. Compared with the elective WT group, the early WT group had significantly lower albumin(Alb)levels and higher neutrophil/lymphocyte ratios and C-reactive protein(CRP)levels but not a lower performance status. The elective WT group underwent more combination chemotherapy than did the early WT group. OS was different between the two groups(230 d vs 340 d, respectively). Multivariate analysis revealed that higher CRP levels, lower Alb levels and monotherapy were significantly related to a poor prognosis. To minimize potential selection bias,patients in the elective WT group were 1:1 propensity score matched with patients in the early WT group; no significant difference in OS was found(303 d vs 311 d, respectively, log-rank P = 0.9832).CONCLUSION A longer WT in patients with A-GC does not appear to be associated with a worse prognosis.
引文
1 International Agency for Research on Cancer.Estimated number of incident cases,both sexes,worldwide(top 10 cancer sites)in 2012.2012;Available from:http://gco.iarc.fr/today/online-analysis-multi-bars?mode=cancermode_population=continentspopulation=900sex=0cancer=29type=0statistic=0prevalence=0color_palette=default
2 International Agency for Research on Cancer.Estimated number of deaths,both sexes,worldwide(top 10 cancer sites)in 2012.2012;Available from:http://gco.iarc.fr/today/online-analysis-multi-bars?mode=cancermode_population=continentspopulation=900sex=0cancer=29type=1statistic=0prevalence=0color_palette=default
3 Kato M,Nishida T,Yamamoto K,Hayashi S,Kitamura S,Yabuta T,Yoshio T,Nakamura T,Komori M,Kawai N,Nishihara A,Nakanishi F,Nakahara M,Ogiyama H,Kinoshita K,Yamada T,Iijima H,Tsujii M,Takehara T.Scheduled endoscopic surveillance controls secondary cancer after curative endoscopic resection for early gastric cancer:a multicentre retrospective cohort study by Osaka University ESD study group.Gut 2013;62:1425-1432[PMID:22914298 DOI:10.1136/gutjnl-2011-301647]
4 Smyth EC,Verheij M,Allum W,Cunningham D,Cervantes A,Arnold D;ESMO Guidelines Committee.Gastric cancer:ESMO Clinical Practice Guidelines for diagnosis,treatment and follow-up.Ann Oncol 2016;27:v38-v49[PMID:27664260 DOI:10.1093/annonc/mdw350]
5 Wagner AD,Grothe W,Haerting J,Kleber G,Grothey A,Fleig WE.Chemotherapy in advanced gastric cancer:a systematic review and meta-analysis based on aggregate data.J Clin Oncol 2006;24:2903-2909[PMID:16782930 DOI:10.1200/JCO.2005.05.0245]
6 Bang YJ,Van Cutsem E,Feyereislova A,Chung HC,Shen L,Sawaki A,Lordick F,Ohtsu A,Omuro Y,Satoh T.Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer(ToGA):a phase 3,open-label,randomised controlled trial.Lancet 2010;376:687-697[PMID:20728210DOI:10.1016/S0140-6736(10)61121-X]
7 Visser E,van Rossum PS,Leeftink AG,Siesling S,van Hillegersberg R,Ruurda JP.Impact of diagnosis-to-treatment waiting time on survival in esophageal cancer patients-A populationbased study in The Netherlands.Eur J Surg Oncol 2017;43:461-470[PMID:27847286 DOI:10.1016/j.ejso.2016.10.017]
8 Grotenhuis BA,van Hagen P,Wijnhoven BP,Spaander MC,Tilanus HW,van Lanschot JJ.Delay in diagnostic workup and treatment of esophageal cancer.J Gastrointest Surg 2010;14:476-483[PMID:20012379 DOI:10.1007/s11605-009-1109-y]
9 Yun YH,Kim YA,Min YH,Park S,Won YJ,Kim DY,Choi IJ,Kim YW,Park SJ,Kim JH,Lee DH,Yoon SJ,Jeong SY,Noh DY,Heo DS.The influence of hospital volume and surgical treatment delay on long-term survival after cancer surgery.Ann Oncol 2012;23:2731-2737[PMID:22553194DOI:10.1093/annonc/mds101]
10 Neal RD,Tharmanathan P,France B,Din NU,Cotton S,Fallon-Ferguson J,Hamilton W,Hendry A,Hendry M,Lewis R,Macleod U,Mitchell ED,Pickett M,Rai T,Shaw K,Stuart N,T?rring ML,Wilkinson C,Williams B,Williams N,Emery J.Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes?Systematic review.Br J Cancer 2015;112Suppl 1:S92-107[PMID:25734382 DOI:10.1038/bjc.2015.48]
11 McCulloch P,Choy A,Martin L.Association between tumour angiogenesis and tumour cell shedding into effluent venous blood during breast cancer surgery.Lancet 1995;346:1334-1335[PMID:7475773 DOI:10.1016/s0140-6736(95)92345-4]
12 Japanese Gastric Cancer Association.Japanese gastric cancer treatment guidelines 2010(ver.3).Gastric Cancer 2011;14:113-123[PMID:21573742 DOI:10.1007/s10120-011-0042-4]
13 Japanese Gastric Cancer Association.Japanese gastric cancer treatment guidelines 2014(ver.4).Gastric Cancer 2017;20:1-19[PMID:27342689 DOI:10.1007/s10120-016-0622-4]
14 Charlson ME,Pompei P,Ales KL,MacKenzie CR.A new method of classifying prognostic comorbidity in longitudinal studies:development and validation.J Chronic Dis 1987;40:373-383[PMID:3558716 DOI:10.1016/0021-9681(87)90171-8]
15 Song H,Fang F,Valdimarsdóttir U,Lu D,Andersson TM,Hultman C,Ye W,Lundell L,Johansson J,Nilsson M,Lindblad M.Waiting time for cancer treatment and mental health among patients with newly diagnosed esophageal or gastric cancer:a nationwide cohort study.BMCCancer 2017;17:2[PMID:28049452 DOI:10.1186/s12885-016-3013-7]
16 Khorana AA,Tullio K,Elson P,Pennell NA,Kalady MF,Raymond D,Klein EA,Abraham J,Grobmyer SR,Monteleone EE,Bolwell BJ.Increase in time to initiating cancer therapy and association with worsened survival in curative settings:A U.S.analysis of common solid tumors.J Clin Oncol 2017;35:6557-6557[DOI:10.1200/JCO.2017.35.15_suppl.6557]
17 Elimova E,Shiozaki H,Slack RS,Chen HC,Wadhwa R,Sudo K,Charalampakis N,Hiremath A,Estrella JS,Matamoros A,Sagebiel T,Das P,Rogers JE,Garris JL,Blum MA,Badgwell B,Ajani JA.Early versus Delayed Therapy of Advanced Gastric Cancer Patients--Does It Make a Difference?Oncology 2015;89:215-220[PMID:26159599 DOI:10.1159/000434647]
18 Del Giudice ME,Young SM,Vella ET,Ash M,Bansal P,Robinson A,Skrastins R,Ung Y,Zeldin R,Levitt C.Guideline for referral of patients with suspected lung cancer by family physicians and other primary care providers.Can Fam Physician 2014;60:711-716,e376-e382[PMID:25122814]
19 Leighl NB,Rekhtman N,Biermann WA,Huang J,Mino-Kenudson M,Ramalingam SS,West H,Whitlock S,Somerfield MR.Molecular testing for selection of patients with lung cancer for epidermal growth factor receptor and anaplastic lymphoma kinase tyrosine kinase inhibitors:American Society of Clinical Oncology endorsement of the College of American Pathologists/International Association for the study of lung cancer/association for molecular pathology guideline.J Clin Oncol 2014;32:3673-3679[PMID:25311215 DOI:10.1200/JCO.2014.57.3055]
20 BTS recommendations to respiratory physicians for organising the care of patients with lung cancer.The Lung Cancer Working Party of the British Thoracic Society Standards of Care Committee.Thorax 1998;53 Suppl 1:S1-S8[PMID:9713437 DOI:10.1016/S0168-5597(96)96026-8]
21 Imrie CW.Host systemic inflammatory response influences outcome in pancreatic cancer.Pancreatology 2015;15:327-330[PMID:25975490 DOI:10.1016/j.pan.2015.04.004]
22 Sugimoto A,Nishida T,Takahashi K,Mukai K,Matsubara T,Hayashi S,Yamamoto M,Nakajima S,Fukui K,Inada M.Chemotherapy and survival benefit in elderly patients with advanced gastric cancer.J Clin Oncol 2017;35:45-45[DOI:10.1200/JCO.2017.35.4_suppl.45]
2 International Agency for Research on Cancer.Estimated number of deaths,both sexes,worldwide(top 10 cancer sites)in 2012.2012;Available from:http://gco.iarc.fr/today/online-analysis-multi-bars?mode=cancermode_population=continentspopulation=900sex=0cancer=29type=1statistic=0prevalence=0color_palette=default
3 Kato M,Nishida T,Yamamoto K,Hayashi S,Kitamura S,Yabuta T,Yoshio T,Nakamura T,Komori M,Kawai N,Nishihara A,Nakanishi F,Nakahara M,Ogiyama H,Kinoshita K,Yamada T,Iijima H,Tsujii M,Takehara T.Scheduled endoscopic surveillance controls secondary cancer after curative endoscopic resection for early gastric cancer:a multicentre retrospective cohort study by Osaka University ESD study group.Gut 2013;62:1425-1432[PMID:22914298 DOI:10.1136/gutjnl-2011-301647]
4 Smyth EC,Verheij M,Allum W,Cunningham D,Cervantes A,Arnold D;ESMO Guidelines Committee.Gastric cancer:ESMO Clinical Practice Guidelines for diagnosis,treatment and follow-up.Ann Oncol 2016;27:v38-v49[PMID:27664260 DOI:10.1093/annonc/mdw350]
5 Wagner AD,Grothe W,Haerting J,Kleber G,Grothey A,Fleig WE.Chemotherapy in advanced gastric cancer:a systematic review and meta-analysis based on aggregate data.J Clin Oncol 2006;24:2903-2909[PMID:16782930 DOI:10.1200/JCO.2005.05.0245]
6 Bang YJ,Van Cutsem E,Feyereislova A,Chung HC,Shen L,Sawaki A,Lordick F,Ohtsu A,Omuro Y,Satoh T.Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer(ToGA):a phase 3,open-label,randomised controlled trial.Lancet 2010;376:687-697[PMID:20728210DOI:10.1016/S0140-6736(10)61121-X]
7 Visser E,van Rossum PS,Leeftink AG,Siesling S,van Hillegersberg R,Ruurda JP.Impact of diagnosis-to-treatment waiting time on survival in esophageal cancer patients-A populationbased study in The Netherlands.Eur J Surg Oncol 2017;43:461-470[PMID:27847286 DOI:10.1016/j.ejso.2016.10.017]
8 Grotenhuis BA,van Hagen P,Wijnhoven BP,Spaander MC,Tilanus HW,van Lanschot JJ.Delay in diagnostic workup and treatment of esophageal cancer.J Gastrointest Surg 2010;14:476-483[PMID:20012379 DOI:10.1007/s11605-009-1109-y]
9 Yun YH,Kim YA,Min YH,Park S,Won YJ,Kim DY,Choi IJ,Kim YW,Park SJ,Kim JH,Lee DH,Yoon SJ,Jeong SY,Noh DY,Heo DS.The influence of hospital volume and surgical treatment delay on long-term survival after cancer surgery.Ann Oncol 2012;23:2731-2737[PMID:22553194DOI:10.1093/annonc/mds101]
10 Neal RD,Tharmanathan P,France B,Din NU,Cotton S,Fallon-Ferguson J,Hamilton W,Hendry A,Hendry M,Lewis R,Macleod U,Mitchell ED,Pickett M,Rai T,Shaw K,Stuart N,T?rring ML,Wilkinson C,Williams B,Williams N,Emery J.Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes?Systematic review.Br J Cancer 2015;112Suppl 1:S92-107[PMID:25734382 DOI:10.1038/bjc.2015.48]
11 McCulloch P,Choy A,Martin L.Association between tumour angiogenesis and tumour cell shedding into effluent venous blood during breast cancer surgery.Lancet 1995;346:1334-1335[PMID:7475773 DOI:10.1016/s0140-6736(95)92345-4]
12 Japanese Gastric Cancer Association.Japanese gastric cancer treatment guidelines 2010(ver.3).Gastric Cancer 2011;14:113-123[PMID:21573742 DOI:10.1007/s10120-011-0042-4]
13 Japanese Gastric Cancer Association.Japanese gastric cancer treatment guidelines 2014(ver.4).Gastric Cancer 2017;20:1-19[PMID:27342689 DOI:10.1007/s10120-016-0622-4]
14 Charlson ME,Pompei P,Ales KL,MacKenzie CR.A new method of classifying prognostic comorbidity in longitudinal studies:development and validation.J Chronic Dis 1987;40:373-383[PMID:3558716 DOI:10.1016/0021-9681(87)90171-8]
15 Song H,Fang F,Valdimarsdóttir U,Lu D,Andersson TM,Hultman C,Ye W,Lundell L,Johansson J,Nilsson M,Lindblad M.Waiting time for cancer treatment and mental health among patients with newly diagnosed esophageal or gastric cancer:a nationwide cohort study.BMCCancer 2017;17:2[PMID:28049452 DOI:10.1186/s12885-016-3013-7]
16 Khorana AA,Tullio K,Elson P,Pennell NA,Kalady MF,Raymond D,Klein EA,Abraham J,Grobmyer SR,Monteleone EE,Bolwell BJ.Increase in time to initiating cancer therapy and association with worsened survival in curative settings:A U.S.analysis of common solid tumors.J Clin Oncol 2017;35:6557-6557[DOI:10.1200/JCO.2017.35.15_suppl.6557]
17 Elimova E,Shiozaki H,Slack RS,Chen HC,Wadhwa R,Sudo K,Charalampakis N,Hiremath A,Estrella JS,Matamoros A,Sagebiel T,Das P,Rogers JE,Garris JL,Blum MA,Badgwell B,Ajani JA.Early versus Delayed Therapy of Advanced Gastric Cancer Patients--Does It Make a Difference?Oncology 2015;89:215-220[PMID:26159599 DOI:10.1159/000434647]
18 Del Giudice ME,Young SM,Vella ET,Ash M,Bansal P,Robinson A,Skrastins R,Ung Y,Zeldin R,Levitt C.Guideline for referral of patients with suspected lung cancer by family physicians and other primary care providers.Can Fam Physician 2014;60:711-716,e376-e382[PMID:25122814]
19 Leighl NB,Rekhtman N,Biermann WA,Huang J,Mino-Kenudson M,Ramalingam SS,West H,Whitlock S,Somerfield MR.Molecular testing for selection of patients with lung cancer for epidermal growth factor receptor and anaplastic lymphoma kinase tyrosine kinase inhibitors:American Society of Clinical Oncology endorsement of the College of American Pathologists/International Association for the study of lung cancer/association for molecular pathology guideline.J Clin Oncol 2014;32:3673-3679[PMID:25311215 DOI:10.1200/JCO.2014.57.3055]
20 BTS recommendations to respiratory physicians for organising the care of patients with lung cancer.The Lung Cancer Working Party of the British Thoracic Society Standards of Care Committee.Thorax 1998;53 Suppl 1:S1-S8[PMID:9713437 DOI:10.1016/S0168-5597(96)96026-8]
21 Imrie CW.Host systemic inflammatory response influences outcome in pancreatic cancer.Pancreatology 2015;15:327-330[PMID:25975490 DOI:10.1016/j.pan.2015.04.004]
22 Sugimoto A,Nishida T,Takahashi K,Mukai K,Matsubara T,Hayashi S,Yamamoto M,Nakajima S,Fukui K,Inada M.Chemotherapy and survival benefit in elderly patients with advanced gastric cancer.J Clin Oncol 2017;35:45-45[DOI:10.1200/JCO.2017.35.4_suppl.45]
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