title: Impact on Survival on Interval between Surgery and Adjuvant Chemotherapy in Completely Resected Stage IB-IIIA Lung Cancer.
abstract: OBJECTIVE
  Complete surgical resection is recommended for early stage lung cancer, and adjuvant chemotherapy is given for stage IB to IIIA disease. No studies have examined the best timing to administer chemotherapy after surgery in lung cancer. This study was to investigate the optimal timing of adjuvant chemotherapy after surgical resection.
  
  
  METHODS
  Data collected from the Taiwan National Health Insurance Research Database between January, 2004 and December, 2010 were retrospectively analyzed. Patients with stage IB to IIIA lung cancer underwent complete surgical resection and adjuvant chemotherapy were included. A total of 1522 patients were included. The patients were divided into 4 groups according to the interval between surgery and chemotherapy: group 1, < 30 days; group 2, 30-45 days; group 3, 46-60 days; group 4 > 60 days. Univariate and multivariate regression analyses were used to identify prognostic factors for overall survival.
  
  
  RESULTS
  The numbers of patients in groups 1, 2, 3, and 4 were 153, 161, 290, and 818, respectively. The 5-year survival rate was 41% in group 1, 48% in group 2, 50% in group 3, and 35% in group 4 (p<0.001). The median survival time was 44.50 months in group 1, 59.53 months in group 2, 67.33 months in group 3 and 36.33 months in group 4 (p<0.001) Survival rate is the poorest when chemotherapy is delayed beyond 60 days after surgical resection Multivariate analysis also indicated the interval between surgery and first course of chemotherapy more than 60 days after surgery was an independent risk factor for survival.
  
  
  CONCLUSIONS
  Timing of chemotherapy after surgery is associated with poorer survival in lung cancer patients.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital and Chung Shan Medical University, Taichung, Taiwan.|Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City 40201, Taiwan.|School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.|Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan.
authors.forename: Bing-Yen
authors.initials: BY
authors.lastname: Wang
authors.affiliation: Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City 40201, Taiwan.|Department of Family and Community Medicine, Chung Shan Medical University Hospial, Taichung 40201, Taiwan.
authors.forename: Jing-Yang
authors.initials: JY
authors.lastname: Huang
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital and Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Wei-Heng
authors.initials: WH
authors.lastname: Hung
authors.affiliation: Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, and Chung Shan Medical University, Taichung, Taiwan.|Department of respiratory care, College of health sciences, Chang Jung Christian University, Tainan, Taiwan.
authors.forename: Ching-Hsiung
authors.initials: CH
authors.lastname: Lin
authors.affiliation: Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, and Chung Shan Medical University, Taichung, Taiwan.|Department of respiratory care, College of health sciences, Chang Jung Christian University, Tainan, Taiwan.
authors.forename: Sheng-Hao
authors.initials: SH
authors.lastname: Lin
authors.affiliation: Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City 40201, Taiwan.|Department of Family and Community Medicine, Chung Shan Medical University Hospial, Taichung 40201, Taiwan.
authors.forename: Yung-Po
authors.initials: YP
authors.lastname: Liaw
authors.affiliation: Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.|Department of Medical Oncology and Chest Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: Jiunn-Liang
authors.initials: JL
authors.lastname: Ko
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D016208:Databases, Factual; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods; D011379:Prognosis; D016016:Proportional Hazards Models; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult