Department of Surgery, Mayo Clinic, Rochester, USA.
Department of Health Sciences Research, Mayo Clinic, Rochester, USA.
Ann Surg Oncol. 2019 Oct;26(10):3240-3249. doi: 10.1245/s10434-019-07566-7. Epub 2019 Jul 22.
Timeliness of care is emerging as a quality indicator for breast cancer care. We sought to evaluate the impact of surgical treatment type on time to adjuvant chemotherapy and impact of treatment delay on survival.
Patients with stage I-III breast cancer treated with both surgery and adjuvant chemotherapy from 2010 to 2014 were identified from the National Cancer Database (NCDB). Delay in treatment was defined as > 120 days from diagnosis to chemotherapy. Multivariable analysis was performed to assess factors associated with delay in treatment and the effect of treatment delay on overall survival.
Of 172,043 patients identified, 89.5% initiated chemotherapy within 120 days of diagnosis. Median time from diagnosis to surgery was shorter in patients undergoing breast conservation (25 days) than mastectomy (29 days, p < 0.001) and within mastectomy patients was shorter for mastectomy without reconstruction (26 versus 35 days, p < 0.001). Time from diagnosis to surgery showed larger differences between surgical groups than time from surgery to chemotherapy. On multivariable analysis of mastectomy patients, reconstruction remained significantly associated with delay to chemotherapy [odds ratio (OR) 1.7, p < 0.001]. For all patients regardless of type of surgery, after adjusting for patient, clinical, and treatment factors, delay of > 120 days from diagnosis to chemotherapy was associated with worse overall survival [hazard ratio (HR) 1.29, p < 0.001].
Initiation of chemotherapy greater than 120 days after diagnosis was associated with poorer overall survival. Time interval from diagnosis to surgery had the greatest impact on time from diagnosis to chemotherapy, with reconstruction resulting in the greatest delay.
及时治疗是乳腺癌治疗的一个质量指标。我们旨在评估手术治疗类型对辅助化疗时间的影响，以及治疗延迟对生存的影响。
从国家癌症数据库（NCDB）中确定了 2010 年至 2014 年接受手术和辅助化疗治疗的 I-III 期乳腺癌患者。治疗延迟定义为诊断后至化疗超过 120 天。采用多变量分析评估与治疗延迟相关的因素，以及治疗延迟对总生存的影响。
在确定的 172043 例患者中，89.5%在诊断后 120 天内开始化疗。接受保乳术的患者从诊断到手术的中位时间（25 天）短于乳房切除术（29 天，p<0.001），而乳房切除术患者中无重建的乳房切除术时间更短（26 天比 35 天，p<0.001）。从诊断到手术的时间在手术组之间的差异大于从手术到化疗的时间。在乳房切除术患者的多变量分析中，重建与化疗延迟显著相关（优势比 1.7，p<0.001）。对于所有患者，无论手术类型如何，在调整患者、临床和治疗因素后，从诊断到化疗的延迟超过 120 天与总体生存较差相关（风险比 1.29，p<0.001）。
诊断后 120 天以上开始化疗与总体生存较差相关。从诊断到手术的时间间隔对从诊断到化疗的时间影响最大，重建导致的延迟最大。
