Strohl Anna E, Feinglass Joseph M, Shahabi Shohreh, Simon Melissa A
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
Department of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
Gynecol Oncol. 2016 Jun;141(3):511-515. doi: 10.1016/j.ygyno.2016.04.014. Epub 2016 Apr 23.
To evaluate factors associated with delayed surgical treatment among women with endometrial cancer.
Using the National Cancer Database (NCDB), we analyzed time to first surgery for epithelial endometrial cancer patients who underwent surgical treatment from 2003 to 2011. Poisson regression was used to examine delays >6weeks between diagnosis and surgery, controlled for patients' sociodemographic and clinical characteristics. Survival for women diagnosed between 2003 and 2006 with timely versus delayed surgery was compared using Cox proportional hazards regression.
The study included 112,041 women diagnosed at 1108 continuously reporting NCDB hospitals. Survival through 2011 was available for 40,184 women. All patients underwent hysterectomy. Twenty-eight percent of patients underwent surgery >6weeks after diagnosis. Poisson regression estimates indicated that being younger than 40years old, being black or Hispanic, having Medicaid or being uninsured, or being from the lowest education quartile were associated with a significantly higher likelihood of surgical wait time>6weeks. Patients diagnosed in 2010-2011 were more likely (IRR 1.32, 95% CI 1.24-1.40) to undergo surgery >6weeks after diagnosis compared to patients treated in 2003. Survival for women with surgical wait times >6weeks was worse than those treated within 6weeks of diagnosis (HR 1.14, 95% CI 1.09-1.20).
Being a minority patient and having lower socioeconomic status or poor insurance coverage were associated with an increased likelihood of delayed surgical treatment. Wait times >6weeks from diagnosis of endometrial cancer to definitive surgery may have a negative impact on survival.
评估子宫内膜癌女性患者手术治疗延迟的相关因素。
利用国家癌症数据库（NCDB），我们分析了2003年至2011年接受手术治疗的上皮性子宫内膜癌患者首次手术的时间。采用泊松回归分析诊断与手术之间超过6周的延迟情况，并对患者的社会人口统计学和临床特征进行了控制。使用Cox比例风险回归比较了2003年至2006年诊断出的女性患者及时手术与延迟手术的生存率。
该研究纳入了在1108家持续上报NCDB的医院诊断出的112,041名女性患者。到2011年有40,184名女性患者的生存数据可用。所有患者均接受了子宫切除术。28%的患者在诊断后超过6周才接受手术。泊松回归估计表明，年龄小于40岁、为黑人或西班牙裔、有医疗补助或未参保、或处于最低教育四分位数与手术等待时间超过6周的可能性显著更高相关。与2003年接受治疗的患者相比，2010 - 2011年诊断出的患者在诊断后超过6周接受手术的可能性更大（发病率比1.32，95%置信区间1.24 - 1.40）。手术等待时间超过6周的女性患者的生存率低于诊断后6周内接受治疗的患者（风险比1.14，95%置信区间1.09 - 1.20）。
作为少数族裔患者以及社会经济地位较低或保险覆盖不足与手术治疗延迟的可能性增加相关。从子宫内膜癌诊断到确定性手术的等待时间超过6周可能会对生存产生负面影响。
