Simunovic Marko, Rempel Eddy, Thériault Marc-Erick, Baxter Nancy N, Virnig Beth A, Meropol Neal J, Levine Mark N
Departments of Surgery.
Can J Surg. 2009 Aug;52(4):E79-E86.
There has been minimal research on the influence of delays for cancer treatments on patient outcomes. We measured the influence of delays to nonemergent colon cancer surgery on operative mortality, disease-specific survival and overall survival. METHODS: We used the linked Surveillance, Epidemiology and End Results (SEER)-Medicare databases (1993-1996) to identify patients who underwent nonemergent colon cancer surgery. We assessed 2 time intervals: surgeon consult to hospital admission for surgery and first diagnostic test for colon cancer to hospital admission. Follow-up data were available to the end of 2003. We selected the time intervals to create patient groups with clinical relevance and they did not extend past 120 days. RESULTS: We identified 7989 patients who underwent nonemergent colon cancer surgery. Median delays from surgeon consult to admission and from first diagnostic test to admission were 7 and 17 days, respectively. The odds of operative mortality were similar if the consult-to-admission interval was 22 days or more versus 1-7 days (odds ratio [OR] 1.0, 95% confidence interval [CI] 0.6-1.8, p = 0.91) or if the test-to-admission interval was 43 days or more versus 1-14 days (OR 0.8, 95% CI 0.4-1.5, p = 0.51), respectively. For these same respective interval comparisons, disease-specific survival was not influenced by the consult-to-admission wait (hazard ratio [HR] 1.0, 95% CI 0.9-1.2, p = 0.91) or the test-to-admission wait (HR 1.0, 95% CI 0.8-1.1, p = 0.63). The risk of death was slightly greater if the consult-to-admission interval was 22 or more days versus 1-7 days (HR 1.1, 95% CI 1.0-1.2, p = 0.013) and if the test-to-admission interval was 43 days or more versus 1-14 days (HR 1.2, 95% CI 1.1-1.3, p = 0.003). CONCLUSION: It is unlikely that delays to nonemergent colon cancer surgery longer than 3 weeks from initial surgical consult or longer than 6 weeks from first diagnostic test negatively impact operative mortality, disease-specific survival or overall survival.
关于癌症治疗延迟对患者预后的影响，相关研究极少。我们测定了非急诊结肠癌手术延迟对手术死亡率、疾病特异性生存率和总生存率的影响。
我们使用了相链接的监测、流行病学与最终结果（SEER）-医疗保险数据库（1993 - 1996年）来识别接受非急诊结肠癌手术的患者。我们评估了两个时间间隔：从外科医生会诊到入院手术以及从结肠癌首次诊断检查到入院。随访数据至2003年底。我们选择这些时间间隔以创建具有临床相关性的患者组，且它们不超过120天。
我们识别出7989例接受非急诊结肠癌手术的患者。从外科医生会诊到入院以及从首次诊断检查到入院的中位延迟分别为7天和17天。如果会诊到入院间隔为22天或更长时间与1 - 7天相比，手术死亡率的比值比相似（比值比[OR]为1.0，95%置信区间[CI]为0.6 - 1.8，p = 0.91）；或者如果检查到入院间隔为43天或更长时间与1 - 十四天相比，手术死亡率的比值比相似（OR为0.8，95% CI为0.4 - 1.5，p = 0.51）。对于这些相同的各自间隔比较，疾病特异性生存率不受会诊到入院等待时间的影响（风险比[HR]为1.0，95% CI为0.9 - 1.2，p = 0.91）或检查到入院等待时间的影响（HR为1.0，95% CI为0.8 - 1.1，p = 0.63）。如果会诊到入院间隔为22天或更长时间与1 - 7天相比，死亡风险略高（HR为1.1，95% CI为1.0 - 1.2，p = 0.013）；如果检查到入院间隔为43天或更长时间与1 - 14天相比，死亡风险略高（HR为1.2，95% CI为1.1 - 1.3，p = 0.003）。
从初次外科会诊起超过3周或从首次诊断检查起超过6周的非急诊结肠癌手术延迟，不太可能对手术死亡率、疾病特异性生存率或总生存率产生负面影响。
