Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC.
Department of Public Health, China Medical University, Taiwan, ROC.
PLoS One. 2019 Jan 14;14(1):e0210465. doi: 10.1371/journal.pone.0210465. eCollection 2019.
Evidence is limited regarding the effect of diagnosis-to-treatment interval (DTI) on the survival of colorectal cancer (CRC) patients. In addition, previous studies on treatment delay and CRC survival have largely grouped patients from all stages (I-IV) into one cohort. Our study provides analysis on each stage individually. We conducted a retrospective cohort study with 39,000 newly diagnosed CRC patients obtained from the Taiwan Cancer Registry Database from 2004-2010 to examine the effect of DTIs on overall survival. DTIs were divided into 3 groups: ≤ 30 days (36,115 patients, 90.5% of study patients), 31-150 days (2,533, 6.4%), and ≥ 151 days (1,252, 3.15%). Risk of death was increased for DTI 31-150 days (hazard ratio 1.51; 95% confidence interval 1.43-1.59) and DTI ≥ 151 days (1.64; 1.54-1.76) compared to DTI ≤ 30. This risk was consistent across all cancer stages. Additional factors that increased risk of death include male gender, age >75, Charlson Comorbidity Index ≥7, other catastrophic illnesses, lack of multidisciplinary team involvement, and treatment in a low volume center. From these results, we advise that the DTI for all CRC patients, regardless of cancer staging, should be 30 days or less.
关于诊断至治疗间隔（DTI）对结直肠癌（CRC）患者生存的影响，相关证据有限。此外，先前关于治疗延迟和 CRC 生存的研究大多将所有分期（I-IV）的患者归入一个队列。我们的研究对每个分期分别进行了分析。我们对 2004 年至 2010 年间从台湾癌症登记数据库中获得的 39,000 例新诊断 CRC 患者进行了回顾性队列研究，以检查 DTI 对总生存的影响。DTI 分为 3 组：≤30 天（36,115 例，占研究患者的 90.5%）、31-150 天（2,533 例，6.4%）和≥151 天（1,252 例，3.15%）。与 DTI ≤ 30 天相比，DTI 31-150 天（风险比 1.51；95%置信区间 1.43-1.59）和 DTI ≥ 151 天（1.64；1.54-1.76）的死亡风险增加。这种风险在所有癌症分期中都是一致的。其他增加死亡风险的因素包括男性、年龄>75 岁、Charlson 合并症指数≥7、其他灾难性疾病、缺乏多学科团队参与以及在低容量中心治疗。根据这些结果，我们建议所有 CRC 患者，无论癌症分期如何，DTI 应在 30 天或更短时间内完成。
