University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, OK, USA.
University of Oklahoma Health Sciences Center, College of Medicine, Stephenson Cancer Center, Oklahoma City, OK, USA.
Ann Surg Oncol. 2021 Oct;28(11):5895-5905. doi: 10.1245/s10434-021-09747-9. Epub 2021 Mar 21.
Time to surgery (TTS) has been suggested to have an association with mortality in early-stage breast cancer.
This study aims to determine the association between TTS and preoperative disease progression in tumor size or nodal status among women diagnosed with clinical T1N0M0 ductal breast cancer.
Women diagnosed with clinical T1N0M0 ductal breast cancer who had breast-conserving surgery as their first definitive treatment between 2010 and 2016 (n = 90,405) were analyzed using the National Cancer Database. Separate multivariable logistic regression models for hormone receptor (HR)-positive and HR-negative patients, adjusted for clinical and demographic variables, were used to assess the relationship between TTS and upstaging of tumor size (T-upstaging) or nodal status (N-upstaging).
T-upstaging occurred in 6.76% of HR-positive patients and 11.00% of HR-negative patients, while N-upstaging occurred in 12.69% and 10.75% of HR-positive and HR-negative patients, respectively. Among HR-positive patients, odds of T-upstaging were higher for 61-90 days TTS (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.05-1.34) and ≥91 days TTS (OR 1.47, 95% CI 1.17-1.84) compared with ≤30 days TTS, and odds of N- upstaging were higher for ≥91 days TTS (OR 1.35, 95% CI 1.13-1.62). No association between TTS and either T- or N-upstaging was found among HR-negative patients. Other clinical and demographic variables, including grade, tumor location, and race/ethnicity, were associated with both T- and N-upstaging.
TTS ≥61 and ≥91 days was a significant predictor of T- and N-upstaging, respectively, in HR-positive patients; however, TTS was not associated with upstaging in HR-negative breast cancer. Delays in surgery may contribute to measurable disease progression in T1N0M0 ductal breast cancer.
手术时间（TTS）与早期乳腺癌的死亡率有关。
本研究旨在确定 TTS 与临床 T1N0M0 导管乳腺癌女性患者肿瘤大小或淋巴结状态术前疾病进展之间的关系。
使用国家癌症数据库分析了 2010 年至 2016 年间接受保乳手术作为首次确定性治疗的临床 T1N0M0 导管乳腺癌女性患者（n=90405）。针对激素受体（HR）阳性和 HR 阴性患者，使用调整临床和人口统计学变量的独立多变量逻辑回归模型，评估 TTS 与肿瘤大小升级（T 升级）或淋巴结状态升级（N 升级）之间的关系。
HR 阳性患者中 T 升级发生率为 6.76%，HR 阴性患者中为 11.00%，HR 阳性患者中 N 升级发生率为 12.69%，HR 阴性患者中为 10.75%。在 HR 阳性患者中，与 TTS≤30 天相比，TTS 61-90 天（比值比 [OR] 1.18，95%置信区间 [CI] 1.05-1.34）和 TTS≥91 天（OR 1.47，95% CI 1.17-1.84）的 T 升级可能性更高，与 TTS≥91 天相比，N 升级的可能性更高（OR 1.35，95% CI 1.13-1.62）。在 HR 阴性患者中，TTS 与 T 或 N 升级均无关联。其他临床和人口统计学变量，包括分级、肿瘤位置和种族/民族，与 T 升级和 N 升级均相关。
TTS≥61 和≥91 天分别是 HR 阳性患者 T 升级和 N 升级的显著预测指标；然而，TTS 与 HR 阴性乳腺癌的升级无关。手术延迟可能导致 T1N0M0 导管乳腺癌发生可测量的疾病进展。
