Amri Ramzi, Bordeianou Liliana G, Sylla Patricia, Berger David L
Division of General Surgery & Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Ann Surg Oncol. 2014 Nov;21(12):3909-16. doi: 10.1245/s10434-014-3800-9. Epub 2014 May 22.
Treatment delay, or the time lapse between diagnosis and surgery, may have a detrimental effect on cancer outcomes. This study assesses the effect of treatment delay on cancer-related outcomes in a large, continuous series of surgically treated colon cancer patients.
All surgical colon cancer cases at our center from 2004 through 2011 were reviewed. Patients who underwent preoperative chemotherapy, emergency admissions, palliative cases, and incidental and postoperative diagnoses were excluded. Treatment delay was correlated with outcomes in univariate and multivariate regression and proportional hazards models.
In 769 included patients, for every treatment-delay quartile increase, odds of death decreased by an odds ratio (OR) of 0.78 (p = 0.001), and metastatic recurrence by OR 0.78 (p = 0.013). Shorter survival duration had a hazard ratio (HR) of 0.81 (p = 0.001) and shorter disease-free survival HR 0.72 (p < 0.001). Multivariate regression adjusting for baseline staging greatly reduces these ratios, and makes them non-significant. Similar patterns were shown in high-risk subsets, including stage III disease, ethnic minorities, patients with positive margins, and extramural vascular invasion.
The inverse relation between treatment delay and survival and recurrence reflected adequate prioritization of advanced and high-risk cases and concurrently showed that, matched for stage and risk categories, treatment delay was not associated with worse cancer outcomes for patients with colon cancer. A reasonable delay between diagnosis and subsequent surgery is not detrimental to patient outcomes and permits more flexibility in scheduling and justifies allowing time to complete proper preoperative evaluation and staging, improving the quality and safety of resection and treatment.
治疗延迟，即诊断与手术之间的时间间隔，可能对癌症治疗结果产生不利影响。本研究评估了治疗延迟对一系列连续接受手术治疗的结肠癌患者的癌症相关结局的影响。
回顾了2004年至2011年在本中心接受手术的所有结肠癌病例。排除接受术前化疗、急诊入院、姑息治疗病例以及偶然和术后诊断的患者。在单变量和多变量回归以及比例风险模型中，将治疗延迟与结局进行关联分析。
在纳入的769例患者中，治疗延迟每增加一个四分位数，死亡几率降低的比值比（OR）为0.78（p = 0.001），转移复发几率降低的OR为0.78（p = 0.013）。较短的生存时间的风险比（HR）为0.81（p = 0.001），无病生存期较短的HR为0.72（p < 0.001）。对基线分期进行多变量回归调整后，这些比值大幅降低且无统计学意义。在高危亚组中也呈现出类似模式，包括III期疾病、少数民族、切缘阳性患者以及壁外血管侵犯患者。
治疗延迟与生存和复发之间的负相关关系反映了对晚期和高危病例的合理优先排序，同时表明，在分期和风险类别相匹配的情况下，治疗延迟与结肠癌患者较差的癌症结局无关。诊断与后续手术之间的合理延迟对患者结局无害，并在安排时间方面提供了更大的灵活性，也为进行适当的术前评估和分期留出时间提供了依据，从而提高了切除和治疗的质量与安全性。
