美国诊断时间、治疗时间与卵巢癌生存之间的关联。
Association between time to diagnosis, time to treatment, and ovarian cancer survival in the United States.
机构信息
Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
出版信息
Int J Gynecol Cancer. 2022 Sep 6;32(9):1153-1163. doi: 10.1136/ijgc-2022-003696.
OBJECTIVE
Evaluate the association between time to diagnosis and treatment of advanced ovarian cancer with overall and ovarian cancer specific mortality using a retrospective cross sectional study of a population based cancer registry database.
METHODS
The Surveillance, Epidemiology, and End Results-Medicare database was searched from 1992 to 2015 for women aged ≥66 years with epithelial ovarian cancer and abdominal/pelvic pain, bloating, difficulty eating, or urinary symptoms within 1 year of cancer diagnosis. Time from presentation to diagnosis and treatment were evaluated as outcomes and covariables. Cox regression models and adjusted Kaplan-Meier curves evaluated 5 year overall and cancer-specific survival.
RESULTS
Among 13 872 women, better survival was associated with longer time from presentation to diagnosis (overall survival hazard ratio (HR) 0.95, 95% confidence interval (CI) 0.94 to 0.95; cancer specific survival HR 0.95, 95% CI 0.94 to 0.96) and diagnosis to treatment (overall survival HR 0.94, 95% CI 0.92 to 0.96; cancer specific survival HR 0.93, 95% CI 0.91 to 0.96). There was longer time from presentation to diagnosis in Hispanic women (relative risk (RR) 1.21, 95% CI 1.12 to 1.32) and from diagnosis to treatment in non-Hispanic black women (RR 1.36, 95% CI 1.21 to 1.54), with lower likelihood of survival at 5 years after adjustment for time to diagnosis and treatment among non-Hispanic black women (HR 1.15, 95% CI 1.05 to 1.26) compared with non-Hispanic white women. Gynecologic oncology visit was associated with improved overall (p<0.001) and cancer specific (p<0.001) survival despite a longer time from presentation to treatment (p<0.001).
CONCLUSION
Longer time to diagnosis and treatment were associated with improved survival, suggesting that tumor specific features are more important prognostic factors than the time interval of workup and treatment. Significant sociodemographic disparities indicate social determinants of health influencing workup and care. Gynecologic oncologist visits were associated with improved survival, highlighting the importance of appropriate referral for suspected ovarian cancer.
目的
通过对人群癌症登记数据库的回顾性横断面研究，评估晚期卵巢癌诊断和治疗时间与总生存率和卵巢癌特异性生存率之间的关系。
方法
从 1992 年至 2015 年，搜索监测、流行病学和最终结果-医疗保险数据库，寻找年龄≥66 岁、患有上皮性卵巢癌且在癌症诊断后 1 年内有腹部/盆腔疼痛、腹胀、进食困难或泌尿系统症状的女性。将从就诊到诊断和治疗的时间作为结局和协变量进行评估。Cox 回归模型和调整后的 Kaplan-Meier 曲线评估了 5 年的总生存率和癌症特异性生存率。
结果
在 13872 名女性中，从就诊到诊断（总生存率风险比 (HR) 0.95，95%置信区间 (CI) 0.94 至 0.95；癌症特异性生存率 HR 0.95，95%CI 0.94 至 0.96）和诊断到治疗（总生存率 HR 0.94，95%CI 0.92 至 0.96；癌症特异性生存率 HR 0.93，95%CI 0.91 至 0.96）的时间较长与更好的生存相关。西班牙裔女性从就诊到诊断的时间更长（相对风险 (RR) 1.21，95%CI 1.12 至 1.32），非西班牙裔黑人女性从诊断到治疗的时间更长（RR 1.36，95%CI 1.21 至 1.54），尽管在调整诊断和治疗时间后，非西班牙裔黑人女性 5 年生存率较低（HR 1.15，95%CI 1.05 至 1.26）与非西班牙裔白人女性相比。尽管从就诊到治疗的时间较长（p<0.001），但妇科肿瘤就诊与总体生存率（p<0.001）和癌症特异性生存率（p<0.001）的改善相关。
结论
诊断和治疗时间的延长与生存率的提高相关，这表明肿瘤特异性特征是比检查和治疗时间间隔更重要的预后因素。显著的社会人口统计学差异表明，健康的社会决定因素影响检查和护理。妇科肿瘤医生的就诊与生存的改善相关，突出了对疑似卵巢癌进行适当转诊的重要性。
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