Flemming J A, Nanji S, Wei X, Webber C, Groome P, Booth C M
Department of Medicine, Queen's University, Kingston, Canada; Department of Public Health Sciences, Queen's University, Kingston, Canada; Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Canada.
Department of Surgery, Queen's University, Kingston, Canada; Department of Oncology, Queen's University, Kingston, Canada.
Eur J Surg Oncol. 2017 Aug;43(8):1447-1455. doi: 10.1016/j.ejso.2017.04.014. Epub 2017 May 6.
Factors associated with time-to-surgery (TTS) and survival in colon cancer has not been well studied. Cancer Care Ontario recommends surgery within 42 days of diagnosis and that 90% of patients meet this benchmark. We describe factors associated with TTS and survival in routine clinical practice.
Retrospective population-based cohort study of patients receiving elective colonic resection after diagnosis of colon cancer in Ontario, Canada from 2002 to 2008 followed until 2012. Factors associated with TTS were identified using multivariate log-binomial and Quantile regression at 42 days and 90th percentiles. The association between TTS and cancer-specific (CSS) and overall survival (OS) were examined using multivariate Cox regression.
4326 patients; median age 71 years and 52% male. Median TTS was 24 days (IQR 14-37); at the 90th percentile 56 days. Factors associated with TTS ≥ 42 days and >90th percentile included older age, co-morbid illness, surgeon volume, and stage I disease (P < 0.05 for all). In patients whose TTS was either at 42 days or 90th percentile, those ≥80 years old waited two weeks longer than those <60 years, individuals with co-morbid illness waited 10 days longer than without co-morbidity, and patients with stage I disease waited 10 days longer than those with stage IV disease (P < 0.05 for all). Delay in TTS > 42 days or >90th percentile was not associated with OS or CSS.
Age, co-morbidity, and stage of cancer are associated with TTS. There was no association between TTS and CSS or OS.
与结肠癌手术时间（TTS）和生存率相关的因素尚未得到充分研究。安大略癌症护理组织建议在诊断后42天内进行手术，且90%的患者应达到这一基准。我们描述了常规临床实践中与TTS和生存率相关的因素。
对2002年至2008年在加拿大安大略省被诊断为结肠癌后接受择期结肠切除术的患者进行基于人群的回顾性队列研究，随访至2012年。使用多变量对数二项式和分位数回归在42天和第90百分位数时确定与TTS相关的因素。使用多变量Cox回归检查TTS与癌症特异性生存率（CSS）和总生存率（OS）之间的关联。
4326例患者；中位年龄71岁，52%为男性。中位TTS为24天（四分位间距14 - 37）；在第90百分位数时为56天。与TTS≥42天和>第90百分位数相关的因素包括年龄较大、合并症、外科医生手术量和I期疾病（所有P<0.05）。在TTS为42天或第90百分位数的患者中，80岁及以上的患者比60岁以下的患者多等待两周，有合并症的个体比无合并症的个体多等待10天，I期疾病患者比IV期疾病患者多等待10天（所有P<0.05）。TTS>42天或>第90百分位数的延迟与OS或CSS无关。
年龄、合并症和癌症分期与TTS相关。TTS与CSS或OS之间无关联。
