Division of Surgical Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California, USA.
Department of Biostatistics, Medical Data Research Center at Providence Health and Services Center, Portland, Oregon, USA.
J Surg Oncol. 2021 Mar;123(4):854-865. doi: 10.1002/jso.26332. Epub 2020 Dec 17.
Most breast cancer (BC) patients present with early disease and clinically negative lymph nodes (cN0). Timing of surgery has not been standardized. We hypothesized that surgical delay results in an increased likelihood of nodal metastasis.
Patients diagnosed with cN0 BC undergoing surgery with sentinel lymph node biopsy as initial therapy between 2006 and 2014 were identified in the NCDB and divided into four groups based on time intervals between diagnosis and surgery (<4 weeks, 4-8 weeks, 8-12 weeks, and >12 weeks). Regression analysis evaluated the independent impact of surgical timing on axillary upstaging and survival.
Of 355,443 patients with cN0 BC, 39.6% had surgery within 4 weeks and 5.4% more than 12 weeks from diagnosis. After controlling for relevant factors, a month delay in surgery was associated with an increased likelihood of nodal positivity (odds ratio: 1.04; 95% confidence interval [CI]: 1.04-1.05; p < .001) and decreased overall survival (hazard ratio: 1.03; 95% CI: 1.02-1.04; p < .001). When compared to patients who underwent surgery less than 4 weeks from diagnosis, the absolute increase in nodal positivity and relative risks were 5.3% (95% CI: 0.047-0.059) and 1.34 (95% CI: 1.30-1.38), respectively, in the more than 12 weeks group.
Delay in BC surgery in cN0 patients was associated with an increased likelihood of axillary upstaging and decreased survival.
大多数乳腺癌（BC）患者的疾病处于早期阶段且临床无淋巴结转移（cN0）。手术时机尚未标准化。我们假设手术延迟会增加淋巴结转移的可能性。
在 NCDB 中确定了 2006 年至 2014 年间接受前哨淋巴结活检作为初始治疗的 cN0 BC 患者，并根据诊断与手术之间的时间间隔将患者分为四组（<4 周、4-8 周、8-12 周和>12 周）。回归分析评估了手术时机对腋窝升级和生存的独立影响。
在 355,443 例 cN0 BC 患者中，39.6%的患者在诊断后 4 周内接受手术，5.4%的患者在诊断后超过 12 周接受手术。在控制了相关因素后，手术延迟一个月与淋巴结阳性的可能性增加相关（优势比：1.04；95%置信区间[CI]：1.04-1.05；p<0.001），总生存时间缩短（风险比：1.03；95%CI：1.02-1.04；p<0.001）。与诊断后 4 周内接受手术的患者相比，诊断后 12 周以上接受手术的患者淋巴结阳性的绝对增加和相对风险分别为 5.3%（95%CI：0.047-0.059）和 1.34（95%CI：1.30-1.38）。
cN0 患者的 BC 手术延迟与腋窝升级的可能性增加和生存时间缩短有关。
