目的:结肠癌(CC)仍然是全球癌症相关死亡的主要原因,结肠切除术代表护理标准。然而,延迟切除对生存结局的影响仍存在争议.我们在CC患者的全国队列中评估了手术时间与10年生存率之间的关系。
方法:这项回顾性队列研究在2004-2020年国家癌症数据库中确定了所有接受I-III期CC结肠切除术的成年人。在诊断后<7天需要新辅助治疗或紧急切除的患者被排除在外。在对手术时间和10年生存率之间的关系进行调整分析后,将患者分为早期(<25天)和延迟(≥25天)队列。生存在1-,5-,通过Kaplan-Meier分析和Cox比例风险模型评估了10年,调整年龄,性别,种族,收入四分位数,保险范围,Charlson-Deyo合并症指数,疾病阶段,肿瘤的位置,接受辅助化疗,以及医院类型,location,和案件量。
结果:在165,991名患者中,84,665(51%)被归类为早期和81,326(49%)延迟。风险调整后,延迟切除与相似的1年相关[风险比(HR)1.01,95%置信区间(CI)0.97-1.04,P=0.72],但低于5年(HR1.24,CI1.22-1.26;P<0.001)和10年生存率(HR1.22,CI1.20-1.23;P<0.001)。黑人种族[调整后的优势比(AOR)1.36,CI1.31-1.41;P<0.001],医疗补助保险范围(AOR1.34,CI1.26-1.42;P<0.001),在高容量医院的护理(AOR1.12,95CI1.08-1.17;P<0.001)与延迟切除的可能性更大相关。
结论:诊断后≥25天接受切除的CC患者1年表现相似,但5年和10年生存率较差,与那些在25天内接受手术的人相比。社会经济因素,包括种族和医疗补助保险,与延迟切除的可能性更大。需要努力平衡适当的术前评估与加速切除,以优化患者的预后。
OBJECTIVE: Colon cancer (CC) remains a leading cause of cancer-related mortality worldwide, for which colectomy represents the standard of care. Yet, the impact of delayed resection on survival outcomes remains controversial. We assessed the association between time to surgery and 10-year survival in a national cohort of CC patients.
METHODS: This retrospective cohort study identified all adults who underwent colectomy for Stage I-III CC in the 2004-2020 National Cancer Database. Those who required neoadjuvant therapy or emergent resection < 7 days from diagnosis were excluded. Patients were classified into Early (< 25 days) and Delayed (≥ 25 days) cohorts after an adjusted analysis of the relationship between time to surgery and 10-year survival. Survival at 1-, 5-, and 10-years was assessed via Kaplan-Meier analyses and Cox proportional hazard modeling, adjusting for age, sex, race, income quartile, insurance coverage, Charlson-Deyo comorbidity index, disease stage, location of tumor, receipt of adjuvant chemotherapy, as well as hospital type, location, and case volume.
RESULTS: Of 165,991 patients, 84,665 (51%) were classified as Early and 81,326 (49%) Delayed. Following risk adjustment, Delayed resection was associated with similar 1-year [hazard ratio (HR) 1.01, 95% confidence interval (CI) 0.97-1.04, P = 0.72], but inferior 5- (HR 1.24, CI 1.22-1.26; P < 0.001) and 10-year survival (HR 1.22, CI 1.20-1.23; P < 0.001). Black race [adjusted odds ratio (AOR) 1.36, CI 1.31-1.41; P < 0.001], Medicaid insurance coverage (AOR 1.34, CI 1.26-1.42; P < 0.001), and care at high-volume hospitals (AOR 1.12, 95%CI 1.08-1.17; P < 0.001) were linked with greater likelihood of Delayed resection.
CONCLUSIONS: Patients with CC who underwent resection ≥ 25 days following diagnosis demonstrated similar 1-year, but inferior 5- and 10-year survival, compared to those who underwent surgery within 25 days. Socioeconomic factors, including race and Medicaid insurance, were linked with greater odds of delayed resection. Efforts to balance appropriate preoperative evaluation with expedited resection are needed to optimize patient outcomes.