Published online Jan 15, 2019. doi: 10.4251/wjgo.v11.i1.28
Peer-review started: September 18, 2018
First decision: October 15, 2018
Revised: November 21, 2018
Accepted: December 17, 2018
Article in press: December 18, 2018
Published online: January 15, 2019
Processing time: 119 Days and 10.9 Hours
It is unclear whether treatment delay affects the clinical outcomes of chemotherapy in advanced gastric cancer (A-GC).
To assess whether treatment delay affects the clinical outcomes of chemotherapy in A-GC.
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).
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).
A longer WT in patients with A-GC does not appear to be associated with a worse prognosis.
Core tip: Generally, most patients with advanced cancer have various additional conditions that are due to the advanced cancer, unlike patients who are candidates for surgery. It is currently unclear whether a delay in the initiation of chemotherapy in patients with advanced gastric cancer (A-GC) leads to adverse outcomes. In the present study, we evaluated the impact of treatment delay on clinical outcomes in patients with A-GC. Using propensity score matched analysis to minimize potential selection bias, we found that there was no significant difference in overall survival between patients in the early waiting time (WT) and elective WT groups. A longer WT in patients with A-GC does not appear to be associated with a worse prognosis.