背景:2019年冠状病毒病(COVID-19)严重阻碍了癌症患者及时获得医疗保健,尤其是女性患者。在治疗等待时间间隔期间,女性患者的抑郁和焦虑比男性患者更明显。在这里,研究治疗延迟对早期癌症女性患者生存结局的影响,可以提高医师的合理和准确的临床决策.
方法:我们从监测中分析了女性的五种癌症,流行病学,和2010年1月至2015年12月的最终结果(SEER)计划。使用单变量和多变量Cox回归分析来确定治疗延迟对患者的总生存期(OS)和癌症特异性生存期(CSS)的影响。
结果:共分析了241,661例早期癌症女性(12,617例非小细胞肺癌(NSCLC),浸润性乳腺癌166,051例,分化型甲状腺癌31,096例,23,550例结直肠癌,宫颈癌8347例)。在I期NSCLC治疗延迟≥3个月的患者中观察到更糟糕的OS率(调整后的危险比(HR)=1.11,95%置信区间(CI):1.01-1.23,p=0.044)和I期浸润性乳腺癌(调整后的HR=1.23,95%CI1.11-1.37,p<0.001)。当治疗延迟间隔作为连续变量分析时,在I期NSCLC患者(adjustedHR=1.04,95%CI1.01~1.06,p=0.010)和I期乳腺癌患者(adjustedHR=1.03,95%CI1.00~1.06,p=0.029)中也观察到了相似的结果.然而,治疗延迟并没有降低分化型甲状腺癌患者的OS,宫颈癌,或早期结直肠癌。只有中间治疗延迟会损害I期宫颈癌患者的CSS(调整后的HR=1.31,95%CI1.02-1.68,p=0.032)。
结论:在调整混杂因素后,从诊断到开始治疗的时间延长(<6个月),对大多数早期女性癌症患者的生存率影响有限.我们的发现是否可以作为支持临床医生在资源有限的情况下对不同癌症患者的治疗延期决定的证据,需要进一步验证。
The coronavirus disease 2019 (COVID-19) severely hindered the timely receipt of health care for patients with cancer, especially female patients. Depression and anxiety were more pronounced in female patients than their male counterparts with cancer during treatment wait-time intervals. Herein, investigating the impact of treatment delays on the survival outcomes of female patients with early-stage cancers can enhance the rational and precise clinical decisions of physicians.
We analyzed five types of cancers in women from the Surveillance, Epidemiology, and End Results (SEER) program between Jan 2010 and Dec 2015. Univariate and multivariate Cox regression analyses were used to determine the impacts of treatment delays on the overall survival (OS) and cancer-specific survival (CSS) of the patients.
A total of 241,661 females with early-stage cancer were analyzed (12,617 cases of non-small cell lung cancer (NSCLC), 166,051 cases of infiltrating breast cancer, 31,096 cases of differentiated thyroid cancer, 23,550 cases of colorectal cancer, and 8347 cases of cervical cancer). Worse OS rates were observed in patients with treatment delays ≥ 3 months in stage I NSCLC (adjustedHazard ratio (HR) = 1.11, 95% Confidence Interval (CI): 1.01-1.23, p = 0.044) and stage I infiltrating breast cancer (adjustedHR = 1.23, 95% CI 1.11-1.37, p < 0.001). When the treatment delay intervals were analyzed as continuous variables, similar results were observed in patients with stage I NSCLC (adjustedHR = 1.04, 95% CI 1.01-1.06, p = 0.010) and in those with stage I breast cancer (adjustedHR = 1.03, 95% CI 1.00-1.06, p = 0.029). However, treatment delays did not reduce the OS of patients with differentiated thyroid cancer, cervical cancer, or colorectal cancer in the early-stage. Only intermediate treatment delays impaired the CSS of patients with cervical cancer in stage I (adjustedHR = 1.31, 95% CI 1.02-1.68, p = 0.032).
After adjusting for confounders, the prolonged time from diagnosis to the initiation of treatment (< 6 months) showed limited negative effects on the survival of most of the patients with early-stage female cancers. Whether our findings serve as evidence supporting the treatment deferral decisions of clinicians for patients with different cancers in resource-limited situations needs further validation.