Ungvari Zoltan, Fekete Mónika, Buda Annamaria, Lehoczki Andrea, Munkácsy Gyöngyi, Scaffidi Paola, Bonaldi Tiziana, Fekete János Tibor, Bianchini Giampaolo, 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 Jun 10. doi: 10.1007/s11357-025-01719-1.
Treatment delay in breast cancer care represents a significant concern in oncology, potentially impacting patient survival outcomes. While various factors can contribute to delayed treatment initiation, the quantitative relationship between specific delay intervals and survival remains incompletely understood in breast cancer management. Our study aims to explore the impact of treatment delays on survival outcomes in breast cancer. A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science databases, covering publications from 2000 to 2025. From an initial 6222 records, 18 eligible studies comprising 25 cohorts were included. Hazard ratios (HRs) for all-cause and breast cancer-specific mortality were extracted or calculated for treatment delays of 4, 8, and 12 weeks. Random-effects meta-analyses were performed, and heterogeneity and publication bias were assessed using I statistics, funnel plots, and Egger's test. This meta-analysis revealed progressively increasing mortality risks with longer treatment delays. For all-cause mortality, HRs increased from 1.12 (95% CI 1.08-1.15) at 4 weeks to 1.25 (95% CI 1.17-1.33) at 8 weeks, and 1.39 (95% CI 1.26-1.53) at 12 weeks. Breast cancer-specific mortality showed more pronounced effects, with HRs of 1.20 (95% CI 1.06-1.36), 1.43 (95% CI 1.11-1.84), and 1.71 (95% CI 1.18-2.49) for 4-, 8-, and 12-week delays, respectively. Analyses combining both survival outcomes demonstrated consistent risk elevation across all time intervals (4 weeks: HR = 1.12, 95% CI 1.09-1.16; 8 weeks: HR = 1.26, 95% CI 1.18-1.34; 12 weeks: HR = 1.41, 95% CI 1.29-1.55). While heterogeneity was significant (I = 54-92%), no substantial publication bias was detected. Delays in initiating breast cancer treatment are associated with significantly worse survival, particularly for cancer-specific mortality. Each additional 4-week delay increases the hazard of death by over 10%, underscoring the urgency of minimizing delays in diagnosis-to-treatment pathways. These findings have critical implications for healthcare systems, clinical decision-making, and public health policy.
乳腺癌治疗延迟是肿瘤学领域的一个重大问题，可能会影响患者的生存结果。虽然多种因素可能导致治疗开始延迟，但在乳腺癌管理中，特定延迟间隔与生存之间的定量关系仍未完全明确。我们的研究旨在探讨治疗延迟对乳腺癌生存结果的影响。我们在PubMed、Scopus和Web of Science数据库中进行了全面的文献检索，涵盖了2000年至2025年的出版物。从最初的6222条记录中，纳入了18项符合条件的研究，包括25个队列。提取或计算了4周、8周和12周治疗延迟的全因死亡率和乳腺癌特异性死亡率的风险比（HRs）。进行了随机效应荟萃分析，并使用I统计量、漏斗图和Egger检验评估了异质性和发表偏倚。这项荟萃分析显示，随着治疗延迟时间的延长，死亡风险逐渐增加。对于全因死亡率，HRs从4周时的1.12（95%CI 1.08-1.15）增加到8周时的1.25（95%CI 1.17-1.33），以及12周时的1.39（95%CI 1.26-1.53）。乳腺癌特异性死亡率的影响更为显著，4周、8周和12周延迟的HRs分别为1.20（95%CI 1.06-1.36）、1.43（95%CI 1.11-1.84）和1.71（95%CI 1.18-2.49）。结合两种生存结果的分析表明，在所有时间间隔内风险均持续升高（4周：HR = 1.12，95%CI 1.09-1.16；8周：HR = 1.26，95%CI 1.18-1.34；12周：HR = 1.41，95%CI 1.29-1.55）。虽然异质性显著（I = 54-92%），但未检测到明显的发表偏倚。乳腺癌治疗开始延迟与显著更差的生存相关，尤其是对于癌症特异性死亡率。每额外延迟4周，死亡风险增加超过10%，这突出了尽量减少诊断至治疗路径中延迟的紧迫性。这些发现对医疗系统、临床决策和公共卫生政策具有关键意义。
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