Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Ann Surg Oncol. 2024 Oct;31(10):6804-6811. doi: 10.1245/s10434-024-15723-w. Epub 2024 Jul 13.
Longer time to surgery (TTS) is associated with worse survival in patients with breast cancer. Whether this association has encouraged more prompt care delivery remains unknown.
The National Cancer Database was used to identify patients ≥18 years of age diagnosed with clinical stage 0-III breast cancer between 2006 and 2019 for whom surgery was the first mode of treatment. A linear-by-linear test for trend assessed median TTS across the interval. Adjusted linear regression modeling was used to examine TTS trends across patient subgroups.
Overall, 1,435,584 patients met the inclusion criteria. The median age was 63 years (interquartile range [IQR] 53-72), 84.3% of patients were White, 91.1% were non-Hispanic, and 99.2% were female. The median TTS in 2006 was 26 days (IQR 16-39) versus 39 days in 2019 (IQR 27-56) [p < 0.001]. In a multivariable linear regression model, TTS increased significantly, with an annual increase of 0.83 days (95% confidence interval 0.82-0.85; p < 0.001). A consistent, significant increase in TTS was observed on subgroup analyses by surgery type, reconstruction, patient race, hospital type, and disease stage. Black race, Hispanic ethnicity, and having either Medicaid or being uninsured were significantly associated with prolonged TTS, as were mastectomy and reconstructive surgery.
Despite evidence that longer TTS is associated with poorer outcomes in patients with breast cancer, TTS has steadily increased, which may be particularly detrimental to marginalized patients. Further studies are needed to ensure the delivery of timely care to all patients.
手术时间（TTS）较长与乳腺癌患者的生存预后较差相关。但目前尚不清楚这种关联是否鼓励了更及时的护理提供。
本研究使用国家癌症数据库，纳入 2006 年至 2019 年间诊断为临床分期 0-III 期乳腺癌且手术为初始治疗模式的年龄≥18 岁患者。线性趋势检验评估了各时间段的 TTS 中位数。采用调整后的线性回归模型，检验了患者亚组的 TTS 趋势。
共有 1435584 例患者符合纳入标准。患者的中位年龄为 63 岁（四分位距 [IQR] 53-72），84.3%为白人，91.1%为非西班牙裔，99.2%为女性。2006 年 TTS 的中位数为 26 天（IQR 16-39），而 2019 年为 39 天（IQR 27-56）（p<0.001）。多变量线性回归模型显示，TTS 显著增加，每年增加 0.83 天（95%置信区间 0.82-0.85；p<0.001）。按手术类型、重建、患者种族、医院类型和疾病分期进行亚组分析，TTS 持续增加。黑人、西班牙裔，以及有医疗补助或没有保险，与 TTS 延长显著相关，此外还与乳房切除术和重建手术相关。
尽管有证据表明 TTS 较长与乳腺癌患者预后较差相关，但 TTS 仍在持续增加，这可能对边缘化患者尤其不利。需要进一步研究以确保所有患者都能及时获得护理。
