Zhang Ye, Hu Yeji, Xi Jinfeng, Wu Bo, Zhang Wenxiong, Li Chunling
Department of Thoracic Surgery, iangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China.
Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
PLoS One. 2025 May 28;20(5):e0319357. doi: 10.1371/journal.pone.0319357. eCollection 2025.
Delaying surgery affects the prognosis of patients with lung cancer, but the critical time point at which it becomes detrimental to survival. Identifying this critical time point may benefit patients and guide clinical practice.
Data from patients diagnosed with stage I-II non-small cell lung cancer (NSCLC) were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression analyses were employed to evaluate prognostic factors associated with overall survival (OS) and to identify time points from diagnosis to surgery that significantly impact prognosis. Kaplan-Meier curves and subgroup analyses were conducted to validate the affect of early versus late surgery on OS. Multinomial logistic regression was utilized to evaluate factors associated with delays in the time from diagnosis to surgery.
We included 55,582 adult patients with stage I-II NSCLC from the SEER database. Time to surgery (TTS) was identified as an independent prognostic factor for OS in stage I-II NSCLC patients through multivariate Cox regression analysis. Compared to surgeries performed within 6 weeks of TTS, those performed after 6 weeks of TTS (HR: 1.22, 95% CI: 1.20-1.25, P < 0.001) were significantly related to poorer OS. Multinomial logistic regression revealed that age, sex, race, and marital status were risk factors for delayed TTS after diagnosis. Compared to patients with a TTS of 0-40 days, those with a TTS of 63-111 days had the following risks: for patients aged ≥ 75 years, the odds ratio (OR) was 1.46 (95% CI: 1.32-1.62, P < 0.001); for males, the OR was 1.15 (95% CI: 1.09-1.20, P < 0.001).
Compared to stage I-II NSCLC patients who underwent surgery more than 6 weeks after diagnosis, those who underwent surgery within 6 weeks had significantly higher survival rates. Delays in surgery were associated with adverse social factors.
手术延迟会影响肺癌患者的预后，但对于生存产生不利影响的关键时间点尚不清楚。确定这一关键时间点可能会使患者受益并指导临床实践。
从监测、流行病学和最终结果（SEER）数据库中提取诊断为I-II期非小细胞肺癌（NSCLC）患者的数据。采用单因素和多因素Cox回归分析评估与总生存期（OS）相关的预后因素，并确定从诊断到手术的时间点对预后有显著影响。进行Kaplan-Meier曲线和亚组分析以验证早期手术与晚期手术对OS的影响。利用多项逻辑回归评估与从诊断到手术时间延迟相关的因素。
我们纳入了SEER数据库中的55582例I-II期NSCLC成年患者。通过多因素Cox回归分析，手术时间（TTS）被确定为I-II期NSCLC患者OS的独立预后因素。与在TTS 6周内进行的手术相比，在TTS 6周后进行的手术（HR：1.22，95%CI：1.20-1.25，P<0.001）与较差的OS显著相关。多项逻辑回归显示，年龄、性别、种族和婚姻状况是诊断后TTS延迟的危险因素。与TTS为0-40天的患者相比，TTS为63-111天的患者有以下风险：对于年龄≥75岁的患者，比值比（OR）为1.46（95%CI：1.32-1.62，P<0.001）；对于男性，OR为1.15（95%CI：1.09-1.20，P<0.001）。
与诊断后6周以上接受手术的I-II期NSCLC患者相比，6周内接受手术的患者生存率显著更高。手术延迟与不良社会因素有关。
