Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, U.S.A.
Laryngoscope. 2020 Jan;130(1):2-11. doi: 10.1002/lary.27892. Epub 2019 Mar 5.
To characterize treatment delays in sinonasal cancer managed with surgery and adjuvant radiation and determine the associated impact on survival.
Retrospective cohort study.
We identified adults in the National Cancer Database treated for sinonasal squamous cell carcinoma with definitive surgery followed by adjuvant radiation from 2004 to 2014. We then examined intervals of diagnosis to surgery (DTS), surgery to radiation (SRT), and radiation duration (RTD). Next, we performed recursive partitioning analysis (RPA) to identify thresholds for these treatment intervals that estimated the greatest differences in survival. We determined the association of treatment delay with overall survival using Cox proportional hazards regression.
Among 2,267 patients included, median durations of DTS, SRT, and RTD were 32, 49, and 47 days, respectively. Predictors of treatment delay included care transitions, black race, and Medicare insurance. We identified thresholds of 26, 64, and 51 days for DTS, SRT, and RTD, respectively, as estimating the largest survival differences. Delays in SRT (hazard ratio [HR] 1.20; 95% confidence interval [CI], 1.03-1.40), and RTD (HR, 1.27; 95% CI, 1.10-1.46) beyond these thresholds independently predicted mortality. Delay in DTS beyond the RPA-derived threshold was not significantly associated with mortality after adjusting for other covariates.
Delays in SRT and RTD intervals are associated with decreased overall survival. Median durations may serve as national benchmarks. Treatment delays could be considered quality indicators for sinonasal cancer treated with surgery and adjuvant radiation.
NA Laryngoscope, 130:2-11, 2020.
描述接受手术和辅助放疗的鼻窦癌患者的治疗延迟情况，并确定其对生存的影响。
回顾性队列研究。
我们在国家癌症数据库中确定了 2004 年至 2014 年间接受手术和辅助放疗治疗鼻窦鳞状细胞癌的成年人。然后，我们检查了诊断至手术（DTS）、手术至放疗（SRT）和放疗持续时间（RTD）的间隔时间。接下来，我们进行了递归分区分析（RPA），以确定这些治疗间隔的阈值，这些阈值估计了生存差异最大的情况。我们使用 Cox 比例风险回归确定治疗延迟与总生存的关系。
在纳入的 2267 例患者中，DTS、SRT 和 RTD 的中位持续时间分别为 32、49 和 47 天。治疗延迟的预测因素包括医疗过渡、黑人种族和医疗保险。我们分别确定了 26、64 和 51 天的 DTS、SRT 和 RTD 阈值，这些阈值估计了最大的生存差异。超过这些阈值的 SRT 延迟（风险比 [HR] 1.20；95%置信区间 [CI] 1.03-1.40）和 RTD 延迟（HR 1.27；95%CI 1.10-1.46）独立预测了死亡率。在调整其他协变量后，超过 RPA 衍生阈值的 DTS 延迟与死亡率无显著相关性。
SRT 和 RTD 间隔的延迟与总生存率降低有关。中位持续时间可作为国家基准。对于接受手术和辅助放疗治疗的鼻窦癌患者，治疗延迟可被视为质量指标。
无。《喉镜》，130：2-11，2020 年。
