Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
Cancer. 2018 Aug 1;124(15):3154-3162. doi: 10.1002/cncr.31533. Epub 2018 May 9.
Multidisciplinary management of head and neck cancer (HNC) must reconcile increasingly sophisticated subspecialty care with timeliness of care. Prior studies examined the individual effects of delays in diagnosis-to-treatment interval, postoperative interval, and radiation interval but did not consider them collectively. The objective of the current study was to investigate the combined impact of these interwoven intervals on patients with HNC.
Patients with HNC who underwent curative-intent surgery with radiation were identified in the National Cancer Database between 2004 and 2013. Multivariable models were constructed using restricted cubic splines to determine nonlinear relations with overall survival.
Overall, 15,064 patients were evaluated. After adjustment for covariates, only prolonged postoperative interval (P < .001) and radiation interval (P < .001) independently predicted for worse outcomes, whereas the association of diagnosis-to-treatment interval with survival disappeared. By using multivariable restricted cubic spline functions, increasing postoperative interval did not affect mortality until 40 days after surgery, and each day of delay beyond this increased the risk of mortality until 70 days after surgery (hazard ratio, 1.14; 95% confidence interval, 1.01-1.28; P = .029). For radiation interval, mortality escalated continuously with each additional day of delay, plateauing at 55 days (hazard ratio, 1.25; 95% confidence interval, 1.11-1.41; P < .001). Delays beyond these change points were not associated with further survival decrements.
Increasing delays in postoperative and radiation intervals are associated independently with an escalating risk of mortality that plateaus beyond certain thresholds. Delays in initiating therapy, conversely, are eclipsed in importance when appraised in conjunction with the entire treatment course. Such findings may redirect focus to streamlining those intervals that are most sensitive to delays when considering survival burden. Cancer 2018. © 2018 American Cancer Society.
头颈部癌症（HNC）的多学科管理必须协调日益复杂的亚专业护理与护理的及时性。先前的研究分别考察了诊断与治疗间隔、术后间隔和放射治疗间隔的延迟对患者的影响，但并未将它们综合考虑。本研究的目的是调查这些相互交织的间隔时间对 HNC 患者的综合影响。
在 2004 年至 2013 年间，从国家癌症数据库中确定了接受根治性手术加放疗的 HNC 患者。使用限制性立方样条建立多变量模型，以确定与总生存期的非线性关系。
共有 15064 例患者接受评估。在调整了协变量后，只有延长的术后间隔（P<0.001）和放射治疗间隔（P<0.001）独立地预示着较差的结果，而诊断与治疗间隔与生存的关系则消失了。通过使用多变量限制性立方样条函数，术后间隔的增加直到手术后 40 天才会影响死亡率，此后每天的延迟都会增加死亡风险，直到手术后 70 天（风险比，1.14；95%置信区间，1.01-1.28；P=0.029）。对于放射治疗间隔，随着延迟天数的增加，死亡率呈连续上升趋势，在 55 天达到平台期（风险比，1.25；95%置信区间，1.11-1.41；P<0.001）。超过这些转折点的延迟与进一步的生存下降无关。
术后和放射治疗间隔的延长与死亡率的风险呈独立递增关系，超过一定的阈值就会达到平台期。相反，在评估整个治疗过程时，延迟开始治疗的重要性就会被掩盖。这些发现可能会重新将注意力集中在那些对延迟最敏感的时间段，以减轻治疗负担对生存率的影响。癌症 2018。©2018 美国癌症协会。
