All authors: Escarpment Cancer Research Institute, McMaster University, Hamilton, ON, Canada.
J Clin Oncol. 2014 Jan 1;32(1):27-33. doi: 10.1200/JCO.2013.51.3671. Epub 2013 Nov 25.
To determine whether wait time from histologic diagnosis of uterine cancer to time of definitive surgery by hysterectomy had an impact on all-cause survival.
Women in Ontario with a confirmed histopathologic diagnosis of uterine cancer between April 1, 2000, and March 31, 2009, followed by surgery were identified in the Ontario Cancer Registry. Survival was calculated by using the Kaplan-Meier method. Factors were evaluated for their prognostic effect on survival by using Cox proportional hazards regression. Wait time was evaluated in a multivariable model after adjusting for other significant factors.
The final study population included 9,417 women; 51.9% had surgery by a gynecologist, and 69.9% had endometrioid adenocarcinoma. Five-year survival for women with wait times of 0.1 to 2, 2.1 to 6, 6.1 to 12, or more than 12 weeks was 71.1%, 81.8%, 79.5%, and 71.9%, respectively. Wait times of ≤ 2 weeks were adversely prognostic for survival after adjusting for other significant factors in the multivariable model, and patients with wait times of more than 12 weeks had worse survival than those who had wait times between 2.1 and 12.0 weeks.
To the best of our knowledge, this is the first report in a large population-based cohort demonstrating that longer wait times from diagnosis of uterine cancer to definitive surgery have a negative impact on overall survival.
确定从子宫癌组织学诊断到子宫切除术的确定性手术的等待时间是否对全因生存产生影响。
在安大略癌症登记处确定了 2000 年 4 月 1 日至 2009 年 3 月 31 日期间确诊为子宫癌并随后接受手术的安大略省妇女。通过 Kaplan-Meier 法计算生存率。使用 Cox 比例风险回归评估因素对生存的预后影响。在调整其他重要因素后，在多变量模型中评估等待时间。
最终研究人群包括 9417 名女性；51.9%的手术由妇科医生进行，69.9%的为子宫内膜样腺癌。等待时间为 0.1 至 2、2.1 至 6、6.1 至 12 或超过 12 周的女性 5 年生存率分别为 71.1%、81.8%、79.5%和 71.9%。在多变量模型中调整其他重要因素后，等待时间≤2 周对生存具有不利的预后影响，且等待时间超过 12 周的患者比等待时间在 2.1 至 12.0 周之间的患者生存更差。
据我们所知，这是首次在大型基于人群的队列中报告表明，从子宫癌诊断到确定性手术的等待时间延长对总生存有负面影响。
