title: Is the improvement of prognosis of patients with metastatic pulmonary adenocarcinoma treated with TCM herbal medicine due to lag time to treatment bias?
abstract: BACKGROUND. Traditional Chinese herbal medicine was associated with improved prognosis in patients with performance score 0-1 at the time of diagnosis of stage IV pulmonary adenocarcinoma (PAC) treated with platinum-based chemotherapy (PBT). OBJECTIVE. The authors investigated the effect of 1- to 4-month lag time to traditional Chinese medicine (TCM) treatment on the median and 1-year survival of PBT-PAC patients.
  
  
  METHODS
  The median lag time to treatment was 3 months. In the first 3 months, about 35% of the patients died, but thereafter the survival curve flattened off and the death of the next 35% to 40% of patients took 9 months. Leaving out patients with lag time up to 3 months therefore would be a reasonable choice. To be on the safe side, the effects of leaving out patients up to 4 months were investigated. The Kaplan-Meier survival curves were used.
  
  
  RESULTS
  The median and 1-year survival of the PBT-PAC patients was 5.0 months and 27%, respectively. Leaving out patients with 0-1 month follow-up, 0-2, 0-3, and 0-4 months follow-up changed the median and 1-year survival, respectively, to 5.5 months and 32%, 6.5 months and 36%, 9.0 months and 43%, and 10.0 months and 52%. The median survival of PBT + TCM in PAC patients was 22.6 months and 78%. Median lag time to TCM treatment was 3.0 months. With up to 4 months lag time to treatment due to combined patients' and TCM doctor's waiting time, the improved survival of PBT + TCM performance score 0-1 (fully ambulant) patients at the time of diagnosis still is significant (P < .01, hazard ratio = 0.51). Moreover, the survival of patients treated by TCM doctors with little or more months lag time to treatment was not different (P = .79).
  
  
  CONCLUSIONS
  Increasing lag time to treatment up to 4 months improves the median and 1-year survival of PBT patients without TCM but is unlikely to explain the greatly improved prognosis of PBT + TCM treated patients with fully ambulant stage IV PAC.
authors.affiliation: Longhua Hospital, Shanghai, China.
authors.forename: Huiru
authors.initials: H
authors.lastname: Guo
authors.forename: Luming
authors.initials: L
authors.lastname: Liu
authors.forename: Jan P A
authors.initials: JP
authors.lastname: Baak
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology; D000077192:Adenocarcinoma of Lung; D004334:Drug Administration Schedule; D004365:Drugs, Chinese Herbal / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008516:Medicine, Chinese Traditional / Q000379:methods; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D008517:Phytotherapy / Q000379:methods; D011379:Prognosis; D013997:Time Factors
chemical_list: D004365:Drugs, Chinese Herbal