PMID- 38025812
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231201
IS  - 2218-6751 (Print)
IS  - 2226-4477 (Electronic)
IS  - 2218-6751 (Linking)
VI  - 12
IP  - 10
DP  - 2023 Oct 31
TI  - Impact of time-to-treatment on survival for early-stage non-small cell lung 
      cancer in The Netherlands-a nationwide observational cohort study.
PG  - 2015-2029
LID - 10.21037/tlcr-23-256 [doi]
AB  - BACKGROUND: Varied outcomes on the relation between time-to-treatment and 
      survival in early-stage non-small cell lung cancer (NSCLC) patients are reported. 
      We examined this relation in a large multicentric retrospective cohort study and 
      identified factors associated with extended time-to-treatment. METHODS: We 
      included 9,536 patients with clinical stage I-II NSCLC, diagnosed and treated in 
      2014-2019, from the Netherlands Cancer Registry that includes nation-wide data. 
      Time-to-treatment was defined as the number of days between first outpatient 
      visit for suspected lung cancer and start of treatment. The effect of extended 
      time-to-treatment beyond the first quartile and survival was studied with Cox 
      proportional hazard regression. Analyses were stratified for stage and type of 
      therapy. Time-to-treatment was adjusted for multiple covariates including 
      performance status and socioeconomic status. Factors associated with treatment 
      delay were identified by multilevel logistic regression. RESULTS: Median 
      time-to-treatment was 47 days [interquartile range (IQR): 34-65] for stage I and 
      46 days (IQR: 34-62) for stage II. The first quartile extended to 33 days for 
      both stages. Risk of death increased significantly with extended 
      time-to-treatment for surgical treatment of clinical stage II patients [adjusted 
      hazard ratio (aHR) >33 days: 1.36, 95% confidence intervals (CI): 1.09-1.70], but 
      not in stage II patients treated with radiotherapy or in stage I patients. Causes 
      of prolonged time-to-treatment were multifactorial including diagnostic tests, 
      such as endoscopic ultrasound (EUS) or endobronchial ultrasound (EBUS). 
      CONCLUSIONS: Clinical stage II patients benefit from fast initiation of surgical 
      treatment. Surprisingly this appears to be accounted for by patients who are 
      clinically stage II but pathologically stage I. Further study is needed on 
      characterizing these patients and the significance of lymph node- or distant 
      micrometastasis in guiding time-to-treatment and treatment strategy.
CI  - 2023 Translational Lung Cancer Research. All rights reserved.
FAU - Klarenbeek, Sosse E
AU  - Klarenbeek SE
AD  - Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud 
      University Medical Center, Nijmegen, The Netherlands.
FAU - Aarts, Mieke J
AU  - Aarts MJ
AD  - Netherlands Cancer Registry, Netherlands Comprehensive Cancer Organization 
      (IKNL), Utrecht, The Netherlands.
FAU - van den Heuvel, Michel M
AU  - van den Heuvel MM
AD  - Department of Pulmonary Diseases, Radboud Institute for Molecular Life Sciences, 
      Radboud Institute for Health Sciences, Radboud University Medical Center, 
      Nijmegen, The Netherlands.
FAU - Prokop, Mathias
AU  - Prokop M
AD  - Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud 
      University Medical Center, Nijmegen, The Netherlands.
FAU - Tummers, Marcia
AU  - Tummers M
AD  - Department for Health Evidence, Radboud Institute for Health Sciences, Radboud 
      University Medical Center, Nijmegen, The Netherlands.
FAU - Schuurbiers-Siebers, Olga C J
AU  - Schuurbiers-Siebers OCJ
AD  - Department of Pulmonary Diseases, Radboud Institute for Molecular Life Sciences, 
      Radboud Institute for Health Sciences, Radboud University Medical Center, 
      Nijmegen, The Netherlands.
LA  - eng
PT  - Journal Article
DEP - 20231009
PL  - China
TA  - Transl Lung Cancer Res
JT  - Translational lung cancer research
JID - 101646875
PMC - PMC10654436
OTO - NOTNLM
OT  - Non-small cell lung cancer (NSCLC)
OT  - cancer registry
OT  - survival
OT  - time-to-treatment
OT  - waiting time
COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure 
      form (available at 
      https://tlcr.amegroups.com/article/view/10.21037/tlcr-23-256/coif). The authors 
      have no conflicts of interest to declare.
EDAT- 2023/11/29 18:43
MHDA- 2023/11/29 18:44
PMCR- 2023/10/31
CRDT- 2023/11/29 16:37
PHST- 2023/04/17 00:00 [received]
PHST- 2023/08/29 00:00 [accepted]
PHST- 2023/11/29 18:44 [medline]
PHST- 2023/11/29 18:43 [pubmed]
PHST- 2023/11/29 16:37 [entrez]
PHST- 2023/10/31 00:00 [pmc-release]
AID - tlcr-12-10-2015 [pii]
AID - 10.21037/tlcr-23-256 [doi]
PST - ppublish
SO  - Transl Lung Cancer Res. 2023 Oct 31;12(10):2015-2029. doi: 10.21037/tlcr-23-256. 
      Epub 2023 Oct 9.