LBPO.PS01 · 人群科学 · Late-Breaking
乳腺癌患者治疗延迟与预后之间的关联：一项基于人群的队列研究
Association between treatment delay and prognosis among breast cancer patients: A population-based cohort study
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
背景：乳腺癌的治疗延迟可能对生存产生不利影响。然而，此类延迟对不同分期生存的影响仍未得到充分表征。
目的：评估女性乳腺癌患者诊断后分期特异性的治疗延迟与5年生存之间的关联。
方法：利用韩国研究卓越临床数据利用网络（K-CURE）乳腺癌公共资料库样本数据（2012-2022年）开展了一项回顾性队列研究。乳腺癌采用国际肿瘤疾病分类第3版（ICD-O-3编码，C50）进行识别。治疗延迟定义为从诊断到首次治疗启动的间隔，分为四组：未治疗、0-30天（参照）、31-60天和≥ 61天。患者从首次诊断日期开始随访，直至死亡、诊断后5年或研究期结束（以先发生者为准）。协变量包括人口统计学特征、若干生活方式因素和合并症。采用Cox比例风险模型估计分期分层的校正风险比（aHR）及死亡的95%置信区间（CI）。根据既往癌症史和随访期间接受的治疗组合进行了敏感性分析和分层分析。
结果：研究纳入I、II、III和IV期乳腺癌患者分别为7,335、6,554、1,941和665例。在接受治疗的患者中，5年生存率在I期为96.9%至97.5%，II期为93.1%至94.5%，III期为71.9%至82.0%，IV期为34.8%至46.5%。与30天内启动治疗相比，未治疗在所有分期中均与较差预后显著相关，而在31-60天或≥ 61天后启动治疗则无此关联。然而，在接受手术、放疗和化疗联合治疗的I期或II期患者中，治疗延迟与略高的死亡风险相关（I期延迟31-60天：aHR 1.99，95% CI 1.00-3.95；II期延迟≥ 61天：aHR 1.91，95% CI 1.07-3.41）。
结论：与接受治疗的患者相比，未治疗的患者在所有分期中结局均较差。相比之下，在诊断后1个月内启动治疗的患者与其后启动治疗的患者之间预后无显著差异。然而，需要三联疗法的患者中的治疗延迟可能对生存产生不利影响，值得开展进一步的大规模研究来验证这些发现。
查看英文原文 English abstract
Background: Treatment delays in breast cancer may adversely affect survival. However, the impact of such delays on survival across stages remains poorly characterized.
Objectives: To evaluate the association between stage-specific treatment delay after diagnosis and 5-year survival among women with breast cancer.
Methods: A retrospective cohort study was conducted using the Korean-Clinical Data Utilization network for Research Excellence (K-CURE) breast cancer public library sample data (2012-2022). Breast cancer was identified using the International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3 code, C50). Treatment delay was defined as the interval from diagnosis to the initiation of the first treatment, categorized into four groups: no treatment, 0-30 days (reference), 31-60 days, and ≥61 days. Patients were followed from the date of first diagnosis until death, 5 years after diagnosis or the end of study period whichever occurred first. Covariates included demographics, several lifestyle factors, and comorbidities. Stage-stratified adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for death were estimated using Cox proportional hazards models. Sensitivity and stratified analyses were conducted based on prior cancer history and treatment combinations received during follow-up.
Results: The study included 7,335, 6,554, 1,941, and 665 patients with stage I, II, III, and IV breast cancer, respectively. Among treated patients, 5-year survival ranged from 96.9% to 97.5% in stage I, 93.1% to 94.5% in stage II, 71.9% to 82.0% in stage III, and 34.8% to 46.5% in stage IV. Compared with treatment initiation within 30 days, no treatment was significantly associated with poorer prognosis across all stages, whereas initiation after 31-60 days or ≥61 days was not. However, among patients with stage I or II who received combined surgery, radiotherapy, and chemotherapy, treatment delays were associated with a slightly higher risk of death (stage I with a 31-60-day delay: aHR 1.99, 95% CI 1.00-3.95; stage II with a ≥61-day delay: aHR 1.91, 95% CI 1.07-3.41).
Conclusions: Untreated patients had poorer outcomes across all stages compared with treated patients. By contrast, prognosis did not differ significantly between patients who initiated treatment within 1 month of diagnosis and those who initiated treatment thereafter. However, treatment delays among patients requiring triple-modality therapy may adversely affect survival, warranting further large-scale studies to validate these findings.
利益披露 Disclosure
H. Kim, None..
J. Baek, None..
S. Lee, None..
A. Shin, None.