Department of Surgery, UCSF East Bay, 1411 E 31St St, Oakland, CA, 94602, USA.
Department of Thoracic Surgery, Kaiser Permanente Northern California, 3600 Broadway, Oakland, CA, 94611, USA.
World J Surg. 2023 May;47(5):1323-1332. doi: 10.1007/s00268-023-06913-w. Epub 2023 Jan 25.
Optimal time to surgery for lung cancer is not well established. We aimed to assess whether time to surgery correlates with outcomes.
We assessed patients 18-84 years old who were diagnosed with stage I/II lung cancer at our integrated healthcare system from 2009 to 2019. Time to surgery was defined to start with disease confirmation (imaging or biopsy) prior to the surgery scheduling date. Outcomes of unplanned return to care within 30 days of lung cancer surgery, all-cause mortality, and disease recurrence were compared based on time to surgery before and after 2, 4, and 12 weeks.
Of 2861 included patients, 70% were over 65 years old and 61% were female. Time to surgery occurred in 1-2 weeks for 6%, 3-4 weeks for 31%, 5-12 weeks for 58%, and 13-26 weeks for 5% of patients. Patients with time to surgery > 4 (vs. ≤ 4) weeks had greater risk of both death (hazard ratio (HR) 1.18, 95% confidence interval (CI) 1.00-1.39) and recurrence (HR 1.33, 95% CI 1.10-1.62). Associations were not statistically significant when dichotomizing time to surgery at 2 or 12 weeks for death (2 week HR 1.23, 95% CI 0.93-1.64; 12 week HR 1.35, 95% CI 0.97-1.88) and recurrence (2 week HR 1.54, 95% CI 0.85-2.80; 12 week HR 2.28, 95% CI 0.80-6.46).
Early stage lung cancer patients with time to surgery within 4 weeks experienced lower rates of recurrence. Optimal time to surgical resection may be shorter than previously reported.
肺癌的最佳手术时机尚未确定。我们旨在评估手术时间是否与结局相关。
我们评估了 2009 年至 2019 年在我们的综合医疗系统中被诊断为 I/II 期肺癌的 18-84 岁患者。手术时间定义为从手术安排日期之前的疾病确诊（影像学或活检）开始。根据手术前 2、4 和 12 周的时间，比较肺癌手术后 30 天内无计划返回治疗、全因死亡率和疾病复发的结果。
在 2861 名纳入患者中，70%的患者年龄超过 65 岁，61%的患者为女性。手术时间为 1-2 周的患者占 6%，3-4 周的患者占 31%，5-12 周的患者占 58%，13-26 周的患者占 5%。手术时间大于 4 周（与小于等于 4 周相比）的患者死亡（风险比（HR）1.18，95%置信区间（CI）1.00-1.39）和复发（HR 1.33，95%CI 1.10-1.62）的风险更高。当将手术时间在 2 周或 12 周时分为死亡（2 周 HR 1.23，95%CI 0.93-1.64；12 周 HR 1.35，95%CI 0.97-1.88）和复发（2 周 HR 1.54，95%CI 0.85-2.80；12 周 HR 2.28，95%CI 0.80-6.46）时，相关性没有统计学意义。
手术时间在 4 周内的早期肺癌患者复发率较低。手术切除的最佳时间可能比之前报道的更短。
