摘要
重要性
Time to surgery（TTS）的重要性是患者和臨床醫(yī)生關(guān)注的問題，但圍繞其對乳腺癌存活率的影響存在爭議。幾乎沒有國家數(shù)據(jù)評估該其聯(lián)系。
目的
通過對美國2個最大的癌癥數(shù)據(jù)庫進(jìn)行單獨(dú)分析，研究從診斷到乳腺癌手術(shù)時間與生存率之間的關(guān)系。
設(shè)計，設(shè)置和參與者
進(jìn)行了兩項獨(dú)立的基于人群的研究，這些研究是從監(jiān)測，流行病學(xué)和最終結(jié)果（SEER）-醫(yī)療保險相關(guān)數(shù)據(jù)庫和國家癌癥數(shù)據(jù)庫（NCDB）中前瞻性收集的國家數(shù)據(jù)。 SEER-Medicare隊列包括65歲以上的Medicare患者，而NCDB隊列包括在美國全美經(jīng)癌癥委員會認(rèn)可的設(shè)施接受護(hù)理的患者。每次分析均通過評估5個間隔（≤30、31-60、61-90、91-120和121-180天）和特定疾病的60天間隔評估了總生存率與診斷和手術(shù)時間之間的關(guān)系 。所有患者均被診斷出患有非炎性，非轉(zhuǎn)移性，浸潤性乳腺癌，并接受了手術(shù)作為初始治療。
主要結(jié)果和衡量指標(biāo)
根據(jù)患者，人口統(tǒng)計學(xué)和腫瘤相關(guān)因素進(jìn)行調(diào)整后，總體生存率和特定疾病生存率隨診斷和手術(shù)時間的變化而變化。
結(jié)果
SEER-Medicare隊列在1992年至2009年之間診斷出94 544名66歲或以上的患者。隨著延遲時間的增加，總體生存率總體降低（危險比[HR]為1.09; 95％CI為1.06-1.13; P <.001），以及患有I期疾病（HR，1.13; 95％CI，1.08-1.18; P <.001）和II期疾病（HR 1.06; 95％CI，1.01-1.11; P = .01）的患者。乳腺癌特異性死亡率每隔60天增加一次（子分布危險比[sHR]為1.26； 95％CI為1.02-1.54； P = .03）。 NCDB的研究評估了2003年至2005年診斷為18歲或以上的115-790名患者。每個增加的時間間隔，總死亡率HR為1.10（95％CI，1.07-1.13； P <0.001），在第一階段（HR，1.16）顯著；在調(diào)整了人口統(tǒng)計學(xué)，腫瘤和治療因素后；僅95％CI，1.12-1.21； P; <。001）和II（HR，1.09； 95％CI，1.05-1.13； P <.001）。
結(jié)論和相關(guān)性
更高的TTS與較低的總體生存率和特定疾病的生存率相關(guān)，而延遲時間的縮短與可與某些標(biāo)準(zhǔn)療法媲美的收益相關(guān)。盡管術(shù)前評估和考慮其他方案（如重建術(shù)）需要時間，但應(yīng)盡可能降低TTS，以提高生存率。
Abstract
Importance Time to surgery (TTS) is of concern to patients and clinicians, but controversy surrounds its effect on breast cancer survival. There remains little national data evaluating the association.
Objective To investigate the relationship between the time from diagnosis to breast cancer surgery and survival, using separate analyses of 2 of the largest cancer databases in the United States.
Design, Setting, and Participants Two independent population-based studies were conducted of prospectively collected national data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare–linked database and the National Cancer Database (NCDB). The SEER-Medicare cohort included Medicare patients older than 65 years, 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 5 intervals (≤30, 31-60, 61-90, 91-120, and 121-180 days) and disease-specific survival at 60-day intervals. All patients were diagnosed with noninflammatory, nonmetastatic, invasive breast cancer and underwent surgery as initial treatment.
Main Outcomes and Measures Overall and disease-specific survival as a function of time between diagnosis and surgery, after adjusting for patient, demographic, and tumor-related factors.
Results The SEER-Medicare cohort had 94?544 patients 66 years or older diagnosed between 1992 and 2009. With each interval of delay increase, overall survival was lower overall (hazard ratio [HR], 1.09; 95% CI, 1.06-1.13; P?<?.001), and in patients with stage I (HR, 1.13; 95% CI, 1.08-1.18; P?<?.001) and stage II disease (HR 1.06; 95% CI, 1.01-1.11; P?=?.01). Breast cancer–specific mortality increased with each 60-day interval (subdistribution hazard ratio [sHR], 1.26; 95% CI, 1.02-1.54; P?=?.03). The NCDB study evaluated 115?790 patients 18 years or older diagnosed between 2003 and 2005. The overall mortality HR was 1.10 (95% CI, 1.07-1.13; P?<?.001) for each increasing interval, significant in stages I (HR, 1.16; 95% CI, 1.12-1.21; P?<?.001) and II (HR, 1.09; 95% CI, 1.05-1.13; P?<?.001) only, after adjusting for demographic, tumor, and treatment factors.
Conclusions and Relevance Greater TTS is associated with 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 options such as reconstruction, efforts to reduce TTS should be pursued when possible to enhance survival.
