Department of Obstetrics and Gynaecology, Hallands Hospital Varberg, Varberg, Sweden.
Regional Cancer Centre Western Sweden, Gothenburg, Sweden.
Acta Oncol. 2022 Jan;61(1):30-37. doi: 10.1080/0284186X.2021.1992006. Epub 2021 Nov 5.
Poor survival rates in different cancer types are sometimes blamed on diagnostic and treatment delays, and it has been suggested that such delays might be related to sociodemographic factors such as education and ethnicity. We examined associations of the wait time from diagnosis to surgery and survival in endometrial cancer (EC) and explored patient and tumour factors influencing the wait time.
In this historical population-based cohort study, The Swedish Quality Registry for Gynaecologic Cancer (SQRGC) was used to identify EC patients who underwent primary surgery between 2010 and 2018. Factors associated with a wait time > 32 d were analysed with logistic regression. The 32-d time point was defined in accordance with the Swedish Standardisation Cancer Care programme. Adjusted Poisson regression analyses were used to analyse excess mortality rate ratio (EMRR).
Out of 7366 women, 5535 waited > 32 d for surgery and 1098 > 70 d. The overall median wait time was 44 d. The factors most strongly associated with a wait time > 32 d were surgery at a university hospital (adjusted odds ratio [OR] 1.34, 95% confidence interval [CI] 1.08-1.66) followed by country of birth (OR 1.31, 95% CI 1.10-1.55) and year of diagnosis. There were no associations between wait time and histology or age. A wait time < 15 d was associated with higher mortality (adjusted EMRR 2.29,95% CI 1.36-3.84) whereas no negative survival impact was seen with a wait time of 70 d. Age, tumour stage, histology and risk group were highly associated with survival, whereas education, country of origin and hospital level did not have any impact on survival.
Surgery within the first two weeks after EC diagnosis was associated with worsened survival. A prolonged wait time did not seem to have any significant adverse effect on prognosis.HighlightsSurgery within the first two weeks after diagnosis of endometrial cancer (EC) was associated with poorer survival.A prolonged wait time to surgery did not worsen prognosis.Delay in time to surgery was associated with sociodemographic factors.
不同癌症类型的生存率较低，有时归咎于诊断和治疗的延迟，有人认为这种延迟可能与教育和种族等社会人口因素有关。我们研究了子宫内膜癌（EC）诊断后到手术的等待时间与生存之间的关系，并探讨了影响等待时间的患者和肿瘤因素。
在这项基于人群的历史队列研究中，使用瑞典妇科癌症质量登记处（SQRGC）来确定 2010 年至 2018 年间接受初次手术的 EC 患者。使用逻辑回归分析与等待时间 > 32 天相关的因素。32 天的时间点是根据瑞典标准化癌症护理计划定义的。使用校正泊松回归分析来分析超额死亡率比（EMRR）。
在 7366 名女性中，5535 人等待手术的时间超过 32 天，1098 人等待时间超过 70 天。总的中位等待时间为 44 天。与等待时间 > 32 天关系最密切的因素是在大学医院进行手术（校正优势比 [OR] 1.34，95%置信区间 [CI] 1.08-1.66），其次是出生地（OR 1.31，95% CI 1.10-1.55）和诊断年份。等待时间与组织学或年龄之间没有关联。等待时间 < 15 天与死亡率升高相关（校正 EMRR 2.29，95% CI 1.36-3.84），而等待时间为 70 天对预后没有负面影响。年龄、肿瘤分期、组织学和风险组与生存高度相关，而教育、原籍国和医院水平对生存没有任何影响。
EC 诊断后两周内进行手术与生存率下降相关。较长的等待时间似乎对预后没有显著的不利影响。
