|
|
Back to 2014 Annual Meeting Posters
Effect of Delay in Surgical Treatment of Colon Cancer on Survival
Farid Jalali*1, Argyrios Ziogas2, Jason a. Zell5, Michael J. Stamos3, Hoda Anton-Culver2, William E. Karnes4
1Department of Medicine, University of California Irvine, Orange, CA; 2Department of Epidemiology, University of California Irvine, Irvine, CA; 3Department of Surgery, University of California Irvine, Orange, CA; 4Department of Medicine, Division of Gastroenterology, University of California Irvine, Orange, CA; 5Department of Medicine, Division of Hematology and Oncology, University of California Irvine, Orange, CA
Background: There has been minimal research on the impact of delay in definitive surgical treatment of colon cancer on patient outcomes. We investigated the time intervals between the diagnosis and the definitive surgical treatment of colon cancer, factors associated with delay, and the effect of delay on survival.
Methods: We used the California Cancer Registry database to identify patients 40 years or older who were diagnosed with colon cancer from 1996 to 2005 and underwent colon cancer surgery. Stage IV colon cancers were excluded to focus the analysis on outcomes for surgical treatments with curative intent. Emergent and urgent cases, defined as having time between diagnosis to surgery interval ≤ 1 day and 2-7 days, respectively, were excluded to assess outcomes of elective cases. Cox proportional hazards model was used to investigate the impact of treatment delay time (TDT), defined as time interval between the diagnosis and the definitive surgical treatment, on five-year overall and disease-specific survival. Covariates adjusted for in multivariate analysis were cancer stage, right vs. left-sided cancer, age, gender, race, socioeconomic status (SES), insurance status, and marital status.
Results: A total of 24,351 patients matched the inclusion criteria. Treatment delay time of 6 to 12 weeks (12.8% of cases) was associated with 26% increased risk of overall mortality (HR 1.26, p<0.0001, CI 1.18-1.36) and 14% increased risk of mortality due to colon cancer (HR 1.14, p=0.0259, CI 1.02-1.29) when compared to patients with TDT < 6 weeks. Survival was even worse with TDT ≥ 12 weeks (2.7% of cases) with 62% and 55% increased risk of overall and cancer-specific mortality, respectively (p<0.0001). Significant factors associated with treatment delay time ≥ 6 weeks were older age (40-49 years, 10.6%, compared with 70-79 years, 15.6%), African American race (African American, 22.2% compared with non-Hispanic White, 14.5%), low SES (lowest SES, 19.1%, compared with highest SES, 13.0%), stage I cancer (stage I, 22.2% compared with stage II and III, 12.3% and 13.4%, respectively), and left-sided cancer (left-sided cancer, 18.1% compared with right-sided cancer, 13.6%). Impact of treatment delay on cancer-specific mortality was most pronounced in stage II cancers (delay 6-12 weeks, HR 1.30, p=0.0171 and delay ≥ 12 weeks, HR 1.99, p=0.0002) and T4 tumors (delay 6-12 weeks, HR 1.35, p=0.0027 and delay ≥ 12 weeks, HR 1.42, p=0.0298).
Conclusions: Delays of 6 weeks or longer in definitive surgical treatment of colon cancer after diagnosis are associated with increased mortality. It is unclear whether this reflects neoplastic progression or other unrecognized factors associated with delay. Until this is clarified, it may be advisable to encourage patients with colon cancer to initiate surgical treatment without significant delay.
Back to 2014 Annual Meeting Posters
|
