Background: A timely systemic therapy of patients with metastasized non-small-cell lung cancer (NSCLC) is a suggestive clinical conception. As the pre-therapeutic management is complex and includes comprehensive immunohistochemical and molecular diagnostics, the time to optimal therapy may be prolonged. Whether the timing of therapy influences the outcome still remains controversial. We investigated the therapy timing and overall survival in subgroups of NSCLC patients in the clinical cancer registry of Lower Saxony. Materials and Methods: Patients with UICC stage IV NSCLC and systemic therapy were included. Early and delayed therapy groups based on the median time from histology to therapy were defined. Median overall survival (mOS) was estimated by the Kaplan–Meier test and compared by the log rank test. Uni- and multivariate Cox regression analyses were used for independent variables. Subgroup analyses were performed according to age, ECOG-PS, metastasis stage (M1a-c) and therapy. Results: We included 1687 patients; of these, the median age was 66.8 years, and 58% of patients were male. The median time to systemic therapy was 33 days, and in our sample, 844 patients were in the early and 843 in the delayed therapy group (TG). Median overall survival of the early TG patients was 9 m vs. 14 m in the delayed TG (p< 0.001). Subgroup analyses confirmed consistent findings among different age, metastasis and ECOG subgroups. Conclusions: UICC IV NSCLC patients with a delayed systemic therapy had a better overall survival than those with an early therapy. This observation supports a (qualified) waiting time for systemic therapies. Therapy timing may also be a relevant confounder in clinical studies.
背景：对转移性非小细胞肺癌（NSCLC）患者进行及时的系统性治疗是一种具有提示性的临床理念。由于治疗前管理复杂，包括全面的免疫组织化学和分子诊断，达到最佳治疗的时间可能会延长。治疗时机是否影响结果仍存在争议。我们在下萨克森州临床癌症登记处调查了NSCLC患者亚组的治疗时机和总生存期。 材料与方法：研究纳入了UICC IV期NSCLC并接受系统性治疗的患者。根据从组织学诊断到治疗的中位时间，定义了早期治疗组和延迟治疗组。采用Kaplan-Meier检验估计中位总生存期（mOS），并通过对数秩检验进行比较。使用单变量和多变量Cox回归分析独立变量。根据年龄、ECOG-PS、转移分期（M1a-c）和治疗方式进行亚组分析。 结果：我们共纳入1687名患者；其中，中位年龄为66.8岁，58%的患者为男性。系统性治疗的中位时间为33天，在我们的样本中，844名患者属于早期治疗组，843名患者属于延迟治疗组。早期治疗组患者的中位总生存期为9个月，而延迟治疗组为14个月（p < 0.001）。亚组分析在不同年龄、转移情况和ECOG亚组中均证实了一致的结果。 结论：UICC IV期NSCLC患者中，延迟系统性治疗的患者比早期治疗的患者具有更好的总生存期。这一观察结果支持系统性治疗存在（有条件的）等待时间。治疗时机也可能是临床研究中的一个相关混杂因素。
肿瘤(癌症)患者之家