Mahmud Salaheddin M, Fong Brian, Fahmy Nader, Tanguay Simon, Aprikian Armen G
Department of Oncology, McGill University, Montreal, Quebec, Canada.
J Urol. 2006 Jan;175(1):78-83; discussion 83. doi: 10.1016/S0022-5347(05)00070-4.
In Canada there is growing concern that waiting time for cancer surgery has been increasing. We used population based data to estimate the average PD for RC in Quebec and assess whether delayed surgery has a negative impact on long-term survival.
We used the provincial billing database of the maladie du Quebec to identify all patients with bladder cancer 18 years or older who underwent RAMQ from 1990 to 2002. PD was calculated as the time elapsed between the most recent transurethral resection and the date of RC. Patients were categorized according to PD tertiles into 3 groups, namely 1) 20 or less, 2) 21 to 47 and (C) 48 days or greater. Cox proportional hazards models were used to assess the effect of PD on overall survival, while adjusting for patient and provider factors.
During the study period 1,592 radical cystectomies were performed. Overall median PD was 33 days (95% CI 30 to 35). Median PD increased from 23 days in 1990 to 50 in 2002. After adjusting for calendar year, and patient and provider variables there were no significant differences in survival among the 3 delay categories. However, patients subject to greater than 12 weeks of delay were at 20% greater risk for dying (95% CI 1.0 to 1.5, p = 0.051).
In line with previous reports PD greater than 12 weeks seems to be associated with a worse long-term prognosis.
在加拿大，人们越来越担心癌症手术的等待时间在增加。我们使用基于人群的数据来估计魁北克省根治性膀胱切除术（RC）的平均等待时间（PD），并评估手术延迟是否会对长期生存产生负面影响。
我们使用魁北克省疾病的省级计费数据库，识别出1990年至2002年期间所有18岁及以上接受根治性膀胱切除术（RC）的膀胱癌患者。等待时间（PD）计算为最近一次经尿道切除术与根治性膀胱切除术日期之间的时间间隔。患者根据等待时间三分位数分为3组，即1）20天或更短，2）21至47天，以及3）48天或更长。使用Cox比例风险模型评估等待时间对总生存的影响，同时对患者和医疗服务提供者因素进行校正。
在研究期间，共进行了1592例根治性膀胱切除术。总体中位等待时间为33天（95%可信区间30至35天）。中位等待时间从1990年的23天增加到2002年的50天。在校正日历年、患者和医疗服务提供者变量后，3个延迟类别之间的生存率没有显著差异。然而，延迟超过12周的患者死亡风险高20%（95%可信区间1.0至1.5，p = 0.051）。
与之前的报告一致，延迟超过12周似乎与更差的长期预后相关。
