Aug 2026· Cancer Epidemiology· Vol 104, pp.
103190
· 0 citations· 31 references
Medicine
TL;DR
It was found that prolonged DTIs to be significantly associated with poorer survival, but cautious interpretation of the results is needed given the potential impact of the waiting time paradox.
Abstract
Importance
Evidence regarding the association of the diagnosis to treatment interval (DTI) and survival can inform clinical care and health policy. Data in this regard are currently lacking for cervical cancer.
Objective
To examine the relationship between the DTI and overall survival (OS) in a contemporary cohort of cervical cancer patients receiving curative surgery.
Methods
We conducted a retrospective cohort study using population-based data of incident cases of cervical cancer diagnosed January 2008-September 2023 followed to December 1st, 2023 in Ontario, Canada. Eligible patients were > 18 years of age with stage I-III disease who received curative surgery. Multivariable Cox Proportional Hazards regression analyses were performed to evaluate the association between the DTI and OS adjusting for important confounders. The DTI was modeled categorically and using restricted cubic splines to visualize non-linear relationships.
Results
1501 incident cases of cervical cancer receiving curative surgery were included. The majority of patients were diagnosed with stage I disease (n = 1185, 79%). The median DTI was 80 (60-107) days. After multivariable adjustment, the hazard ratio (HR) estimates were elevated for the shortest and longest DTIs: >2-6 weeks HR: 2.33 (95%CI 1.14-4.77); >22-26 weeks HR: 1.76 (95%CI 0.59-5.27); in comparison to the middle referent interval >10-14 weeks. The restricted cubic splines exhibited a U-shaped pattern of risk, with higher effect estimates among the lowest and highest DTI values.
Conclusion
In this population-based study we did not find that prolonged DTIs to be significantly associated with poorer survival. Cautious interpretation of the results is needed given the potential impact of the waiting time paradox.
ABSTRACT For cervical cancer, the choice between definitive radiotherapy (RT) and surgery has long been a topic of debate. Clinical factors, including histology and tumor burden, have been examined in prior studies. Given recent advances in RT and the incorporation of concurrent chemotherapy, our study seeks to assess the optimal treatment modality for cervical cancer in current clinical practice. The cancer registry database of a medical center was screened for cervical cancer patients. Patients receiving curative intent RT or surgery were included. Clinicopathological factors and treatment outcomes were retrospectively collected. The disease‐free survival (DFS) and overall survival (OS) were analyzed using Cox regression and Kaplan–Meier analyses. From 2007 to 2021, 369 squamous cell carcinoma (SCC) and 108 adenocarcinoma (AC) cases were enrolled. AC had an increasing proportion over time and was associated with worse survival. Comparing RT to surgery, RT was associated with inferior survival in both early‐stage AC (DFS, HR: 8.29, p < 0.001, 95% CI: 3.21–21.42) and SCC group (DFS, HR: 4.01, p < 0.001, 95% CI: 1.99–8.08). The difference was more robust in those with tumors smaller than 4 cm. For advanced‐stage disease, the inferiority of RT was observed in the SCC (DFS, HR: 1.85, p = 0.020, 95% CI: 1.10–3.11), but not AC group. There was no statistically significant intergroup difference observed between the AC and SCC groups regarding DFS of RT versus surgery. In our analysis, AC was an independent poor prognostic factor. Despite the addition of concurrent chemotherapy and advanced RT techniques, surgery‐based treatment was still associated with superior survival for early‐stage cervical cancer.
Yu-Lun Wu, C. Ho, Wen-Shiung Liou et al.· Kaohsiung Journal of Medical...· 0 citations
Purpose To investigate the relationship between time to treatment initiation (TTI) of definitive radiotherapy and survival outcomes in locally advanced head and neck cancers (LAHNC). Methods We retrospectively included patients diagnosed between 2005 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. The multivariate regression analysis, recursive partition analysis, penalized spline function, chi-square test, Kaplan-Meier method, and multivariate Cox proportional-hazards models were used for statistical analyses. Results A total of 18657 patients were included. Patients were stratified into 3 groups: no delay (<36 days), at risk of delay (36-61 days), and delay (>61 days). Compared to patients who initiated radiotherapy within 61 days, patients who initiated radiotherapy after 61 days had a higher risk of death in 5-year cancer-specific survival (CSS) (no delay vs. at risk of delay vs. delay: 58.7% vs. 60.5% vs. 50.5%) (P<0.001) and overall survival (OS) (no delay vs. at risk of delay vs. delay: 47.7% vs. 49.5% vs. 39.4%) (P<0.001). Patients in the delay group had worse outcomes in CSS (hazard ratio [HR], 1.209; 95% confidence interval [CI], 1.143-1.278; P<0.001) and OS (HR, 1.199; 95% CI, 1.146-1.256; P<0.001). In patients with oral cavity, oropharyngeal, and laryngeal cancers, the risk of death progressively rose as the treatment was delayed. However, there was no significant difference in the risk among patients with hypopharyngeal cancer. Conclusions For patients with LAHNC, delay of definitive radiotherapy leads to inferior survival. Our study highlights that the threshold of 36 and 61 days significantly affects survival and identifies patients experiencing these delays.
Lin-Feng Guo, Li-Mei Lin, Zhen-Zhen Lu et al.· Cancer Control: Journal of t...· 0 citations
Interventions addressing primary care attachment and upstream social determinants may improve early detection and access to curative therapy in lung cancer stage at diagnosis and surgical treatment persist in Ontario.
N. Hanna, Saad Shakeel, G. Akhtar-Danesh et al.· PLoS ONE· 0 citations
The findings suggest that efforts to shorten DTI may improve patient survival in this population of patients with stage I non-adenocarcinoma NSCLC treated with SBRT in Ontario.
Cassidy Laub, Paul Nguyen, M. Jalink et al.· McMaster University Medical...· 0 citations
Background Comorbidity is a key determinant of treatment decisions in older cancer patients; however, its role in shaping initial treatment allocation among older women with gynecologic malignancies remains insufficiently characterized. We aimed to evaluate the association between comorbidity burden and treatment selection and to develop a clinically interpretable predictive model. Methods We retrospectively analyzed 972 women aged ≥65 years with newly diagnosed cervical, ovarian, or endometrial cancer treated at a tertiary hospital in Southwest China between 2019 and 2024. Disease-specific guideline-concordant standard treatment was defined as curative-intent initial treatment appropriate for tumor type and FIGO stage, including surgery, platinum-based chemotherapy, concurrent chemoradiotherapy, brachytherapy, or combined-modality treatment when indicated. Multivariable logistic regression was used to identify independent predictors of disease-specific guideline-concordant standard treatment, and a predictive model was developed and internally validated with assessments of discrimination, calibration, and clinical utility. Results Of the 972 patients, 63.7% received disease-specific guideline-concordant standard treatment. Higher comorbidity burden [Charlson Comorbidity Index (CCI) ≥ 4], ECOG performance status ≥2, age ≥75 years, and pulmonary disease were independently associated with lower odds of receiving disease-specific guideline-concordant standard treatment (all p < 0.05). In contrast, higher body mass index and serum albumin levels were associated with higher odds of receiving disease-specific guideline-concordant standard treatment. The final model demonstrated strong internally validated discriminatory performance (AUC = 0.933, 95% CI: 0.917–0.948), good calibration, and meaningful clinical utility across a wide range of decision thresholds. Conclusion In this pooled real-world observational cohort of older women with cervical, ovarian, or endometrial cancer, comorbidity burden was independently associated with receipt of disease-specific guideline-concordant standard treatment. The internally validated host-factor-oriented model may support individualized treatment discussions as an adjunct to multidisciplinary assessment, but it should not be interpreted as a tumor-specific treatment algorithm or as a replacement for disease-specific guideline-based decision-making. Further external validation and tumor-specific prospective studies are needed before broader clinical implementation.
Lin Tang, Yuhang Liu, Bin Chen et al.· Frontiers in Medicine· 0 citations
OBJECTIVE
The objective of the present study was to explore the prevalence, risk and prognostic factors for bone metastases (BM) developement in patients with initial gastric cancer (GC).
METHODS
A total of 30,817 patients with GC in the Surveillance, Epidemiology and End Results (SEER) database, diagnosed from 2010 to 2016, were used to investigate the incidence and associated risk factors for BM developments using multivariate logistic regression. Among those, 1397 and 1121 BM patients were selected to identify independent prognostic factors for BM overall survival (OS) and cancer-specific survival (CSS) using multivariate Cox regression respectively.
RESULT
A total of 1397 (4.53%) GC patients were diagnosed with BM at initial diagnosis. Younger age (<60 years), white race, cardia cancer, signet ring cell, higher grade, tumor size between 2.1 and 4.0 cm, the presence of regional lymph nodes (RLN) metastases, brain metastases, liver metastases, and lung metastases were positively associated with BM development. Conversely, a lower T stage was negatively associated with BM development compared to the T4 stage. The median survival time for GC patients with BM decreased dramatically to 5 months. The presence of RLN metastases was an independent predictor of worse overall survival and cancer-specific survival. Conversely, T2 stage and chemotherapy were associated with better overall survival and cancer-specific survival. Additionally, patients with cardia cancer had favorable cancer-specific survival.
CONCLUSION
The prognosis of gastric cancer patients with BM was dismal. Our findings of several risk factors for BM development and prognostic factors for BM patients could be useful for clinical surveillance and individualized treatment.
Thanh Tùng Hoàng, Tuấn Sỹ Anh Bùi, Manh Nguyen et al.· Asian Pacific Journal of Can...· 0 citations
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