Ungvari Zoltan, Fekete Mónika, Fekete János Tibor, Lehoczki Andrea, Buda Annamaria, Munkácsy Gyöngyi, Varga Péter, Ungvari Anna, Győrffy Balázs
Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA.
Geroscience. 2025 Apr 8. doi: 10.1007/s11357-025-01648-z.
Delaying the initiation of cancer treatment increases the risk of mortality, particularly in colorectal cancer (CRC), which is among the most common and deadliest malignancies. This study aims to explore the impact of treatment delays on mortality in CRC. A systematic literature search was conducted in PubMed, Web of Science, and Scopus for studies published between 2000 and 2025. Meta-analyses were performed using random-effects models with inverse variance method to calculate hazard ratios (HRs) for both overall and cancer-specific survival at 4-, 8-, and 12-week treatment delay intervals, with heterogeneity assessed through I-statistics and publication bias evaluated using funnel plots and Egger's test. A total of 20 relevant studies were included in the meta-analysis. The analyses of all patients demonstrated a progressively increasing risk of 12-39% with longer treatment delays (4 weeks, HR = 1.12; 95% CI, 1.08-1.16; 8 weeks, HR = 1.24; 95% CI, 1.16-1.34; 12 weeks, HR = 1.39; 95% CI, 1.25-1.55). In particular, incrementally higher hazard ratios were observed for all-cause mortality at 4 weeks (HR = 1.14; 95% CI, 1.09-1.18), 8 weeks (HR = 1.29; 95% CI, 1.20-1.39), and 12 weeks (HR = 1.47; 95% CI, 1.31-1.64). In contrast, cancer-specific survival analysis showed a similar trend but did not reach statistical significance (4 weeks, HR = 1.07; 95% CI, 0.98-1.18; 8 weeks, HR = 1.15; 95% CI, 0.95-1.39; 12 weeks, HR = 1.23; 95% CI, 0.93-1.63). Treatment delays in colorectal cancer patients were associated with progressively worsening overall survival, with each 4-week delay increment leading to a substantially higher mortality risk. This study suggests that timely treatment initiation should be prioritized in clinical practice, as these efforts can lead to substantial improvements in survival rates.
延迟癌症治疗的开始会增加死亡风险，尤其是在结直肠癌（CRC）中，结直肠癌是最常见且最致命的恶性肿瘤之一。本研究旨在探讨治疗延迟对结直肠癌患者死亡率的影响。在PubMed、科学网和Scopus数据库中进行了系统的文献检索，以查找2000年至2025年间发表的研究。采用随机效应模型和逆方差法进行荟萃分析，计算在治疗延迟4周、8周和12周时总体生存和癌症特异性生存的风险比（HR），通过I统计量评估异质性，并使用漏斗图和埃格检验评估发表偏倚。荟萃分析共纳入20项相关研究。对所有患者的分析表明，随着治疗延迟时间延长，风险逐渐增加12%-39%（4周，HR = 1.12；95%CI，1.08-1.16；8周，HR = 1.24；95%CI，1.16-1.34；12周，HR = 1.39；95%CI，1.25-1.55）。特别是，在4周（HR = 1.14；95%CI，1.09-1.18）、8周（HR = 1.29；95%CI，1.20-1.39）和12周（HR = 1.47；95%CI，1.31-1.64）时，全因死亡率的风险比逐渐升高。相比之下，癌症特异性生存分析显示出类似趋势，但未达到统计学显著性（4周，HR = 1.07；95%CI，0.98-1.18；8周，HR = 1.15；95%CI，0.95-1.39；12周，HR = 1.23；95%CI，0.93-1.63）。结直肠癌患者的治疗延迟与总体生存率逐渐恶化相关，每延迟4周，死亡风险大幅升高。本研究表明，在临床实践中应优先考虑及时开始治疗，因为这些措施可显著提高生存率。
