The diagnosis to surgery interval and overall survival in patients with cervical cancer

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.