Section of Endocrine Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Ann Surg Oncol. 2021 Jul;28(7):3556-3565. doi: 10.1245/s10434-021-09797-z. Epub 2021 Mar 25.
Longer time to surgery worsens survival in multiple malignancies, including lung, colorectal, and breast cancers, but limited data exist for well-differentiated thyroid cancer. We sought to investigate the impact of time to surgery on overall survival in patients with papillary thyroid cancer.
In a retrospective cohort study of the National Cancer Database, we used Cox proportional hazard models to investigate overall survival as a function of time between diagnosis and surgery for adults with papillary thyroid cancer, adjusting for demographic, patient, and cancer-related variables. Time to surgery was investigated both as a continuous variable and as intervals of 0-90 days, 90-180 days, and > 180 days. Subgroup analyses were conducted by T stage.
Overall, 103,812 adults with papillary thyroid cancer were included from 2004 to 2016. Median follow-up was 55.2 months (interquartile range 28.4-89.5). Increasing time to surgery was associated with increased mortality: delaying by 91-180 days increased the risk by 30% (adjusted hazard ratio [aHR] 1.30, 95% CI 1.19-1.43) and delaying by over 180 days increased the risk by 94% (aHR 1.94, 95% CI 1.68-2.24). Five-year overall survival was 95.7% for 0-90 days, 93.0% for 91-180 days, and 87.9% for over 180 days. On subgroup analysis, increasing delay was associated with worse overall survival for T1, T2, and T3 tumors, but not T4 tumors.
Increasing time to surgery in papillary thyroid cancer is associated with reduced overall survival. Further research is necessary to assess the impact of surgical delay on disease-specific survival.
在多种恶性肿瘤中，包括肺癌、结直肠癌和乳腺癌，手术时间延长会降低生存率，但关于分化型甲状腺癌的数据有限。我们旨在研究手术时间对甲状腺乳头状癌患者总生存率的影响。
在国家癌症数据库的回顾性队列研究中，我们使用 Cox 比例风险模型来研究甲状腺乳头状癌患者诊断与手术之间的时间对总生存率的影响，同时调整了人口统计学、患者和癌症相关变量。手术时间既作为连续变量进行研究，也作为 0-90 天、90-180 天和>180 天的间隔进行研究。进行了 T 分期的亚组分析。
总体而言，2004 年至 2016 年期间纳入了 103812 名患有甲状腺乳头状癌的成年人。中位随访时间为 55.2 个月（四分位间距 28.4-89.5）。手术时间的延长与死亡率的增加相关：延迟 91-180 天会使风险增加 30%（调整后的危险比[aHR] 1.30，95%CI 1.19-1.43），而延迟超过 180 天会使风险增加 94%（aHR 1.94，95%CI 1.68-2.24）。0-90 天的 5 年总生存率为 95.7%，91-180 天为 93.0%，超过 180 天为 87.9%。在亚组分析中，对于 T1、T2 和 T3 肿瘤，延迟时间的增加与总生存率降低相关，但对于 T4 肿瘤则不然。
在甲状腺乳头状癌中，手术时间的延长与总生存率降低有关。需要进一步研究来评估手术延迟对疾病特异性生存率的影响。
