1 Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA.
Otolaryngol Head Neck Surg. 2018 Aug;159(2):283-292. doi: 10.1177/0194599818758020. Epub 2018 Feb 20.
Objective To characterize treatment times in salivary cancer; associate treatment times with patient, tumor, and treatment characteristics; and examine the association of treatment times and overall survival. Study Design Retrospective cohort. Setting Commission-on-Cancer Accredited Hospitals 2004-2013. Subjects and Methods In total, 5953 patients with salivary cancer included in the National Cancer Database were identified. For each treatment interval, patients in the fourth quartile ("prolonged") were compared to patients in the first and second quartiles ("not prolonged"). Patient, tumor, and treatment characteristics were associated with prolonged times via multivariable binary logistic regression. Prolongation of each interval was associated with overall survival via multivariable Cox proportional hazards regression, controlling for clinically relevant factors. Results Median durations for diagnosis-to-treatment initiation, surgery-to-radiation treatment (RT), RT duration, total treatment package, and diagnosis-to-treatment end were 31, 44, 47, 92, and 110 days, respectively. Race, insurance status, comorbidities, age, T and N stage, facility volume and location, and a facility care transition from diagnosis to initial treatment were associated with prolonged treatment time. Prolonged RT duration was associated with decreased overall survival (OS) (62% vs 75% 5-year OS, HR = 1.26 [95% confidence interval (CI), 1.09-1.47]; P = .002), but prolonged diagnosis-to-treatment initiation, surgery-to-RT, total treatment package, and diagnosis-to-treatment end intervals were not (70% vs 67% 5-year OS, HR = 1.11 [95% CI, 0.92-1.34], P = .284; 72% vs 68%, HR = 0.93 [95% CI, 0.79-1.09], P = .370; 70% vs 70%, HR = 1.00 [95% CI, 0.84-1.20], P = .974; 66% vs 71%, HR = 0.99 [95% CI, 0.84-1.18], P = .920, respectively). Conclusion The median durations identified here can serve as reference points. Radiation therapy duration is associated with overall survival in salivary cancer and could be considered a quality indicator.
描述唾液腺癌的治疗时间；将治疗时间与患者、肿瘤和治疗特征相关联；并探讨治疗时间与总生存期的关系。
回顾性队列研究。
2004 年至 2013 年，癌症委员会认证的医院。
共纳入国家癌症数据库中的 5953 名唾液腺癌患者。对于每个治疗间隔，第四四分位（“延长”）的患者与第一和第二四分位（“未延长”）的患者进行比较。多变量二元逻辑回归将患者、肿瘤和治疗特征与延长时间相关联。多变量 Cox 比例风险回归控制了临床相关因素，将每个间隔的延长与总生存期相关联。
诊断至治疗开始、手术至放射治疗（RT）、RT 持续时间、总治疗方案和诊断至治疗结束的中位时间分别为 31、44、47、92 和 110 天。种族、保险状况、合并症、年龄、T 和 N 期、设施量和位置以及从诊断到初始治疗的设施治疗过渡与治疗时间延长相关。RT 持续时间延长与总生存期降低相关（62% vs. 75%，5 年 OS，HR=1.26[95%CI，1.09-1.47]；P=0.002），但诊断至治疗开始、手术至 RT、总治疗方案和诊断至治疗结束的间隔延长并不如此（70% vs. 67%，5 年 OS，HR=1.11[95%CI，0.92-1.34]，P=0.284；72% vs. 68%，HR=0.93[95%CI，0.79-1.09]，P=0.370；70% vs. 70%，HR=1.00[95%CI，0.84-1.20]，P=0.974；66% vs. 71%，HR=0.99[95%CI，0.84-1.18]，P=0.920）。
这里确定的中位数可以作为参考点。放射治疗持续时间与唾液腺癌的总生存期相关，可作为质量指标。
