Delayed diagnosis to treatment interval (DTI) in head & neck cancers – A systematic review and meta-analysis

IF 4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Oral oncology Pub Date : 2024-11-21 DOI:10.1016/j.oraloncology.2024.107106

Noémie Villemure-Poliquin , Rui Fu , Karolina Gaebe , Jin Kwon , Marc Cohen , Marianne Ruel , Kennedy Ayoo , Andrew Bailey , Madette Galapin , Julie Hallet , Antoine Eskander

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Abstract

Introduction

Delayed diagnosis to treatment interval (DTI) in head and neck cancers (HNC) can significantly impact patient outcomes. The need for multimodal treatment in HNC may cause delays in initiation of treatment. This systematic review aims to provide a comprehensive understanding of the consequences of delayed DTI on both oncologic and QoL outcomes, proposing a new quality benchmark along the treatment continuum of HNC patients.

Methods

We searched MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL databases for trials and cohort studies evaluating the impact of delayed DTI in patients with HNC. Outcomes included overall survival (OS), disease-free survival (DFS), locoregional (LRR) and local recurrences (LR) and distant metastasis.

Results

Our search strategy initially identified 10,779 titles and abstracts, of which 63 articles met inclusion criteria for a total of 873,718 patients. The pooled analysis showed that treatment initiation within 30 days improved OS by 9 % compared to longer intervals (aHR: 1.09 [1.06–1.13]; I² = 80 %), with no significant associations found for DFS, LRR, LR, or distant metastasis.

Conclusion

While adherence to a 30-day DTI may be associated with improved survival in some HNC patients, significant heterogeneity in the data limits the generalizability of this finding. Further research with more refined analyses, including adjustments for treatment modality and cancer stage, is necessary. Additionally, gaps remain in the literature, particularly in the methodological limitations related to DTI classification.

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头颈部癌症从诊断到治疗的延迟时间间隔（DTI）--系统回顾和荟萃分析。

导言：头颈部癌症（HNC）从诊断到治疗的时间间隔（DTI）延迟会严重影响患者的预后。HNC 患者需要接受多模式治疗，这可能会导致治疗延迟。本系统性综述旨在全面了解延迟 DTI 对肿瘤学和 QoL 结果的影响，为 HNC 患者的连续治疗提出一个新的质量基准：我们在 MEDLINE、Embase、CENTRAL、Web of Science 和 CINAHL 数据库中检索了评估延迟 DTI 对 HNC 患者影响的试验和队列研究。结果包括总生存期（OS）、无病生存期（DFS）、局部区域（LRR）、局部复发（LR）和远处转移：我们的检索策略初步确定了10779篇标题和摘要，其中63篇符合纳入标准，共纳入873718名患者。汇总分析结果显示，30天内开始治疗与更长的治疗间隔相比，OS提高了9%（aHR：1.09 [1.06-1.13]；I2 = 80%），但在DFS、LRR、LRR或远处转移方面未发现显著关联：虽然坚持 30 天 DTI 可能与一些 HNC 患者生存率的提高有关，但数据的显著异质性限制了这一发现的普遍性。有必要进一步研究更精细的分析，包括对治疗方式和癌症分期的调整。此外，文献中仍存在空白，尤其是在与 DTI 分类相关的方法学限制方面。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Oral oncology 医学-牙科与口腔外科

CiteScore

8.70

自引率

10.40%

发文量

505

审稿时长

20 days

期刊介绍： Oral Oncology is an international interdisciplinary journal which publishes high quality original research, clinical trials and review articles, editorials, and commentaries relating to the etiopathogenesis, epidemiology, prevention, clinical features, diagnosis, treatment and management of patients with neoplasms in the head and neck. Oral Oncology is of interest to head and neck surgeons, radiation and medical oncologists, maxillo-facial surgeons, oto-rhino-laryngologists, plastic surgeons, pathologists, scientists, oral medical specialists, special care dentists, dental care professionals, general dental practitioners, public health physicians, palliative care physicians, nurses, radiologists, radiographers, dieticians, occupational therapists, speech and language therapists, nutritionists, clinical and health psychologists and counselors, professionals in end of life care, as well as others interested in these fields.