Table 4. Time from surgery to AC administration and impact on survival in real-life practice.
| Study | Number of patients received AC | Period of recruitment | Median time from surgery to AC administration | Impact of delayed AC on survival |
|---|---|---|---|---|
| Salazar et al., 2017, (32) | 12,473 | Retrospective (2004 → 2012) | 48 (range, 18–127) days | Lower mortality risk when AC initiated in the 50 days after lung surgery (95% CI: 39–56) |
| No increased of mortality risk for patients who received AC later (i.e., between 57 to 127 days after resection): HR (95% CI): 1.037 (0.972–1.105); P=0.27 | ||||
| Booth et al., 2013, (36) | 1,032 | Retrospective (2004 → 2006) | 8 (range, 1–16) weeks | No difference observed in 4-year OS between patients who started AC from 1 to 10 weeks after lung resection with those who received delayed AC from 11 to 16 weeks after surgery (64% vs. 61%; P=0.758) |
| 35% cases initiated AC more than 10 weeks after surgery | ||||
| Ramsden et al., 2015, (37) | 158 | Retrospective (2005 → 2010) | 8 (range, 3.7–20.3) weeks | – |
| 24% cases initiated AC more than 10 weeks after surgery | ||||
| Zhu et al., 2016, (38) | 409 | Retrospective (2003 → 2013) | 81.9% patients underwent postoperative AC within 46 days: median 34 (range, 25–45) days | No significant difference in terms of DFS between patients receiving AC either within 46 days after surgery {median DFS [95% CI]: 467 [450–552] days} or after 46 days from surgery {median DFS [95% CI]: 474 [400–623] days}; P=0.775 |
| 18.1% patients underwent postoperative AC in more than 46 days: median 53.5 (range, 46–228) days | ||||
| Zhai et al., 2016, (39) | 865 | Retrospective (2001 → 2013) | 62% of patients received AC between 4 to 6 weeks after surgery | – |
| Velcheti et al., 2007, (40) | 40 | Retrospective (2003 → 2005) | 49 (range, 16–188) days | – |
| Lee et al., 2011, (34) | 148 | Retrospective (2000 → 2009) | 28.1±10.7 days in thoracotomy group | – |
| 26.9±7.5 days in thoracoscopic lobectomy group | ||||
| Jiang et al., 2011, (35) | 110 | Retrospective (2004 → 2010) | 33.7±10.9 days in VATS group | – |
| 34±13.3 days in thoracotomy group | ||||
| Sorensen et al., 2015, (41) | 126 | Retrospective (2005 → 2012) | Mean time: 41 days | – |
| Teh et al., 2014, (42) | 44 | Retrospective (2008 → 2013) | 55.7±3.1 days in VATS resection group vs. 68.2±4.3 days in thoracotomy group (P=0.046) | – |
| Shukuya et al., 2009, (43) | 25 | Retrospective (2005 → 2008) | Median time from surgery to AC: 41 (range, 29–79) days | – |
| Wang et al., 2016, (44) | 1,522 | Retrospective (2004 → 2010) | 10% patients received AC <30 days after surgery | Patients who received AC >60 days after surgery have a shorter OS compared to other patients who received AC <60 days after surgery (P=0.0034) |
| 17.1% received AC between 0–45 days after surgery | ||||
| 19.05% received AC between 45–60 days after surgery | ||||
| 53.7% received AC >60 days after surgery |
AC, adjuvant chemotherapy; OS, overall survival; DFS, disease-free survival; VATS, video-assisted thoracic surgery.