Influence of the time interval from diagnosis to treatment on survival for early-stage liver cancer.

Abstract

OBJECTIVES:Liver cancer is the fifth most common cancer in men and the ninth most common cancer in women, and the WHO expects that there will be 1,341,344 cases in 2034 worldwide. Liver cancer also has the second-highest cancer death rate, accounting for 7% of all cancers. The study is going to explore the relationship between time interval from diagnosis to treatment and survival status of early-stage liver cancer patients. MATERIALS AND METHODS:This is a retrospective cohort study using the national database from Taiwan. The datasets include the Taiwan Cancer Registry Database (TCR), the National Health Insurance Research Database (NHIRD), and the National Registry of Deaths. The target population for the study was patients newly diagnosed with stage I and stage II liver cancer between the years 2004 and 2010. Total of 26,038 cases were included in the study. Except descriptive analysis, the relationship between patient characteristics and the time interval from diagnosis to treatment was examined by chi-square tests. In addition, modified Cox proportional hazard models were used to analyze the hazard ratio of patient death with various treatment delay durations. RESULTS:There were 20,430 patients (78.46%) who received treatment less than 30 days after diagnosis, while 2,674 patients (10.27%) received treatment between 31 and 60 days after diagnosis, and 2,068 patients (7.94%) received treatment between 61 and 180 days after diagnosis, and 866 patients (3.33%) who received treatment 181 days after diagnosis. Those treated more than 181 days and 61-180 days after diagnosis had a 1.68-fold increased risk of death (95% confidence interval: 1.50-1.88) and a 1.39-fold increased risk of death (95% confidence interval: 1.31-1.17), respectively. Being male, being elderly, having a higher CCI level, and being treated in a hospital with a low service volume were factors associated with a poorer prognosis. CONCLUSION:Overall, this study utilized a national cohort to conclude that for early-stage liver cancer patients, a longer the time interval from diagnosis to treatment results in a lower survival rate.