Time to Surgery and Breast Cancer Survival in the United States.
Time to Surgery and Breast Cancer Survival in the United States.
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DOI：
10.1001/jamaoncol.2015.4508
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发表时间：
2016-03
期刊：
影响因子：
28.4
通讯作者：
Egleston BL
中科院分区：
文献类型：
--
作者：
Bleicher RJ;Ruth K;Sigurdson ER;Beck JR;Ross E;Wong YN;Patel SA;Boraas M;Chang EI;Topham NS;Egleston BL
手术时间（TTS）是患者和临床医生关注的问题，但围绕其对乳腺癌生存率的影响存在争议。几乎没有国家数据评估该协会。通过对美国两个最大的癌症数据库的单独分析，研究从诊断到乳腺癌手术的时间与生存率之间的关系。两项独立的基于人群的研究，使用监测流行病学和最终结果（SEER）-医疗保险相关数据库（SMDB）和国家癌症数据库（NCDB）前瞻性收集国家数据。SMDB队列包括>65岁的Medicare患者，NCDB队列包括在美国各地的癌症委员会认证机构接受治疗的患者。每项分析通过评价≤30、31-60、61-90、91-120和121-180天的间隔以及60天间隔的疾病特异性生存期，评估了总生存期作为诊断和手术之间时间的函数。所有患者均被诊断为非炎性、非转移性、浸润性乳腺癌，并接受手术作为初始治疗。在调整患者、人口统计学和肿瘤相关因素后，作为诊断和手术之间时间的函数的总体和疾病特异性生存期。SMDB队列有94，544例≥66岁的患者，诊断时间为1992 - 2009年。随着间期延长，总生存率降低（风险比[HR] 1.09，p<0.001），I期（HR 1.13，p<0.001）和II期（HR 1.06，p=0.010）患者的总生存率降低。乳腺癌特异性死亡率随着每60天间隔的增加而增加（亚危险比[sHR] 1.26，p= 0.03）。NCDB研究评估了2003 - 2005年诊断的115，790例≥18岁的患者。在每个增加的时间间隔内，总死亡率HR为1.10（p<0.001），仅在I期（HR 1.16，p<0.001）和II期（1.09，p<0.001）中具有显著性，调整了人口统计学、肿瘤和治疗因素。TTS越大，总体和疾病特异性生存率越低，延迟时间缩短与某些标准治疗的获益相当。虽然术前评估和考虑重建等选择需要时间，但应尽可能减少TTS以提高生存率。
Time to surgery (TTS) is of concern to patients and clinicians, but controversy surrounds its impact on breast cancer survival. There remains little national data evaluating the association. To investigate the relationship between the time from diagnosis to breast cancer surgery and survival, using separate analyses of two of the largest cancer databases in the United States. Two independent population-based studies of prospectively-collected national data utilizing the Surveillance Epidemiology and End Results (SEER)-Medicare-linked database (SMDB), and the National Cancer Database (NCDB). The SMDB cohort included Medicare patients >65 years of age, and the NCDB cohort included patients cared for at Commission on Cancer-accredited facilities throughout the United States. Each analysis assessed overall survival as a function of time between diagnosis and surgery by evaluating intervals encompassing ≤30, 31–60, 61–90, 91–120, and 121–180 days in length, and disease-specific survival at 60-day intervals. All patients were diagnosed with noninflammatory, nonmetastatic, invasive breast cancer and underwent surgery as initial treatment. Overall and disease-specific survival as a function of time between diagnosis and surgery, after adjusting for patient, demographic and tumor-related factors. The SMDB cohort had 94,544 patients ≥66 years old, diagnosed 1992 – 2009. With each interval delay increase, overall survival was lower overall (hazard ratio [HR] 1.09, p<0.001), and in stage I (HR 1.13, p<0.001) and II (HR 1.06, p=0.010) patients. Breast cancer-specific mortality increased with each 60-d interval (subhazard ratio [sHR] 1.26, p= 0.03). The NCDB study evaluated 115,790 patients ≥18 years old, diagnosed 2003 – 2005. The overall mortality HR was 1.10 (p<0.001) for each increasing interval, significant in stages I (HR 1.16, p<0.001) and II (1.09, p<0.001) only, adjusting for demographic, tumor and treatment factors. Greater TTS confers lower overall and disease-specific survival, and a shortened delay is associated with benefits comparable to some standard therapies. Although time is required for preoperative evaluation and consideration of some options such as reconstruction, efforts to reduce TTS should be pursued where possible to enhance survival.