英国皇后大学癌症研究所Timothy P Hanna团队研究了癌症治疗延误与死亡率风险增加的相关性。2020年11月4日，该研究发表在《英国医学杂志》上。

为了量化癌症治疗延误与死亡率的关系，研究组在Medline数据库中检索2000年1月1日至2020年4月10日发表的研究，包括膀胱癌、乳腺癌、结肠癌、直肠癌、肺癌、子宫颈癌和头颈癌的手术、全身治疗或放疗、新辅助和辅助适应症治疗。主要结局为每种癌症每延误四周的总生存风险比。

该研究共纳入34项针对17种适应症的研究，涉及1272681例患者。对于五种放疗指征或宫颈癌手术，未发现高有效性数据。在17种适应症中，有13种癌症治疗延误显著增加了死亡率。

手术结果是一致的，癌症治疗每延迟四周的死亡风险比为1.06-1.08。全身治疗的估计死亡风险比相差较大，为1.01-1.28。放疗的估计死亡风险比包括针对头颈部癌的根治性放疗（风险比为1.09）、保乳手术后的辅助放疗（0.98）和子宫颈癌辅助放疗（1.23）。排除干扰因素后的敏感性分析并未改变研究结果。

研究结果表明，癌症治疗延迟四个星期，包括手术、全身治疗和放疗等，将导致七种癌症的死亡率增加。

附：英文原文

Title: Mortality due to cancer treatment delay: systematic review and meta-analysis

Author: Timothy P Hanna, Will D King, Stephane Thibodeau, Matthew Jalink, Gregory A Paulin, Elizabeth Harvey-Jones, Dylan E O’Sullivan, Christopher M Booth, Richard Sullivan, Ajay Aggarwal

Issue&Volume: 2020/11/04

Abstract:

Objective To quantify the association of cancer treatment delay and mortality for each four week increase in delay to inform cancer treatment pathways.

Design Systematic review and meta-analysis.

Data sources Published studies in Medline from 1 January 2000 to 10 April 2020.

Eligibility criteria for selecting studies Curative, neoadjuvant, and adjuvant indications for surgery, systemic treatment, or radiotherapy for cancers of the bladder, breast, colon, rectum, lung, cervix, and head and neck were included. The main outcome measure was the hazard ratio for overall survival for each four week delay for each indication. Delay was measured from diagnosis to first treatment, or from the completion of one treatment to the start of the next. The primary analysis only included high validity studies controlling for major prognostic factors. Hazard ratios were assumed to be log linear in relation to overall survival and were converted to an effect for each four week delay. Pooled effects were estimated using DerSimonian and Laird random effect models.

Results The review included 34 studies for 17 indications (n=1272681 patients). No high validity data were found for five of the radiotherapy indications or for cervical cancer surgery. The association between delay and increased mortality was significant (P<0.05) for 13 of 17 indications. Surgery findings were consistent, with a mortality risk for each four week delay of 1.06-1.08 (eg, colectomy 1.06, 95% confidence interval 1.01 to 1.12; breast surgery 1.08, 1.03 to 1.13). Estimates for systemic treatment varied (hazard ratio range 1.01-1.28). Radiotherapy estimates were for radical radiotherapy for head and neck cancer (hazard ratio 1.09, 95% confidence interval 1.05 to 1.14), adjuvant radiotherapy after breast conserving surgery (0.98, 0.88 to 1.09), and cervix cancer adjuvant radiotherapy (1.23, 1.00 to 1.50). A sensitivity analysis of studies that had been excluded because of lack of information on comorbidities or functional status did not change the findings.

Conclusions Cancer treatment delay is a problem in health systems worldwide. The impact of delay on mortality can now be quantified for prioritisation and modelling. Even a four week delay of cancer treatment is associated with increased mortality across surgical, systemic treatment, and radiotherapy indications for seven cancers. Policies focused on minimising system level delays to cancer treatment initiation could improve population level survival outcomes.

DOI: 10.1136/bmj.m4087

Source: https://www.bmj.com/content/371/bmj.m4087