Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2019; 11(1): 28-38
Published online Jan 15, 2019. doi: 10.4251/wjgo.v11.i1.28
Impact of time from diagnosis to chemotherapy in advanced gastric cancer: A Propensity Score Matching Study to Balance Prognostic Factors
Tsutomu Nishida, Aya Sugimoto, Ryo Tomita, Yu Higaki, Naoto Osugi, Kei Takahashi, Kaori Mukai, Tokuhiro Matsubara, Dai Nakamatsu, Shiro Hayashi, Masashi Yamamoto, Sachiko Nakajima, Koji Fukui, Masami Inada
Tsutomu Nishida, Aya Sugimoto, Ryo Tomita, Yu Higaki, Naoto Osugi, Kei Takahashi, Kaori Mukai, Tokuhiro Matsubara, Dai Nakamatsu, Shiro Hayashi, Masashi Yamamoto, Sachiko Nakajima, Koji Fukui, Masami Inada, Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
Author contributions: Nishida T analyzed the data and wrote the manuscript; Nishida T and Sugimoto A collected the data; Nishida T, Sugimoto A, Tomita R, Higaki Y, Osugi N, Takahashi K, Mukai K, Matsubara, Nakamatsu D, Hayashi S, Yamamoto M, Nakajima S, Fukui K and Inada M provided medical care for the patients enrolled in this study.
Institutional review board statement: The present study was conducted in accordance with the Declaration of Helsinki, and approval was obtained from the Institutional Review Board of the Toyonaka Municipal Hospital (2018-06-06).
Informed consent statement: This is a retrospective study involving human data that was previously collected and did not require the additional recruitment of human subjects; thus, the need for informed consent was waived via the opt-out method of our hospital website.
Conflict-of-interest statement: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tsutomu Nishida, MD, PhD, Doctor, Department of Gastroenterology, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka 560-8565, Japan. tnishida.gastro@gmail.com
Telephone: +81-6-68430101 Fax: +81-6-68583531
Received: September 18, 2018
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
ARTICLE HIGHLIGHTS
Research background

It is unclear whether treatment delay affects the clinical outcomes of chemotherapy in advanced gastric cancer (A-GC). It is ethically impossible to evaluate the impact of the waiting time (WT) on prognosis in a randomized clinical trial.

Research motivation

It is currently unclear whether a delay in the initiation of chemotherapy in patients with 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.

Research objectives

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.

Research methods

We defined the WT as the interval between diagnosis and chemotherapy initiation. We evaluated the influence of WT on overall survival (OS).

Research 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 (NLR) and C-reactive protein (CRP) levels but not a lower performance status (PS). The elective WT group underwent more combination chemotherapy than 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).

Research conclusions

A longer WT in patients with A-GC does not appear to be associated with worse prognosis.

Research perspectives

The longer WT for patients with A-GC did not appear to be associated with a worse prognosis compared with the shorter WT. However, we must always evaluate patients as rapidly as possible to reduce the patient’s anxiety.