PDF(Pubmed)
Abstract：
The treatment process of tumors in surgical patients is typically prompt and efficient, whereas non-surgical patients are more prone to treatment delay due to various factors. However, the relationship between treatment delay and survival outcomes in non-surgical Esophageal cancer (EC) patients has received limited study. This study aims to evaluate the impact of waiting time from diagnose to treatment on survival outcomes among non-surgical EC patients in Shandong Province, China. Over a 20-year follow-up period, a total of 12,911 patients diagnosed with EC and not receiving surgical intervention were identified from 2000 to 2020. The Kaplan-Meier methodology was employed to determine overall survival (OS) and cancer-specific survival (CSS). Univariate and multivariate Cox regression analyses were performed to evaluate the impact of treatment delays on future outcomes. The nonlinear association between waiting time and survival outcomes was investigated using restricted cubic spline (RCS) functions. The average delay in initiating EC treatment from the initial medical consultation for symptoms of EC was 1.18 months (95%CI=1.16-1.20). Patients with a long delay (≥3 months) in treatment demonstrated significantly lower rates of 1-, 3-, and 5-year OS and CSS compared to those with a brief delay in treatment initiation. A long delay in EC treatment independently associated with an increased risk of mortality from all causes and cancer. The association between waiting time and both all-cause and cause-specific mortality illustrated a pronounced J-shaped pattern. The prolong delay in treatment initiation significantly impacts the OS and CSS outcomes for non-surgical EC patients. Timely administration of treatment has the potential to enhance survival outcomes in patients with EC who are ineligible for surgery, including those in advanced stages without surgical options available.
摘要：
手术患者肿瘤的治疗过程通常是迅速而有效的，而非手术患者由于各种因素更容易出现治疗延误。然而,非手术食管癌(EC)患者治疗延迟与生存结局之间的关系研究有限.本研究旨在评估山东省非手术EC患者从诊断到治疗的等待时间对生存结局的影响。中国。经过20年的随访，从2000年至2020年,共发现12,911例确诊为EC且未接受手术治疗的患者.采用Kaplan-Meier方法来确定总生存期(OS)和癌症特异性生存期(CSS)。进行单变量和多变量Cox回归分析以评估治疗延迟对未来结局的影响。使用受限三次样条（RCS）函数研究了等待时间与生存结果之间的非线性关联。从EC症状的初始医疗咨询开始EC治疗的平均延迟为1.18个月（95CI=1.16-1.20）。长期延迟治疗（≥3个月）的患者表现出1-，3-,和5年OS和CSS相比，那些在治疗开始时短暂延迟。EC治疗的长期延迟与各种原因和癌症的死亡风险增加独立相关。等待时间与全因死亡率和特定原因死亡率之间的关联显示出明显的J形模式。治疗开始的延长延迟显著影响非手术EC患者的OS和CSS结果。及时给予治疗有可能提高不符合手术条件的EC患者的生存结果。包括那些没有手术选择的晚期。
