Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver · 2025
Diagnostic delay at diagnosis and time-to-treatment influence overall survival of pancreatic cancer patients.
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Ponz de Leon Pisani Ruggero, Archibugi Livia, Lazzano Pilar, Bina Niccolò, Vanella Giuseppe, Lauri Gaetano, Tacelli Matteo, Apadula Laura, Tamburrino Domenico, Aleotti Francesca, Guarneri Giovanni, Orsi Giulia, Macchini Marina, de Carolis Lilia, Marengon Ilaria, Rossi Gemma, Zaccari Piera, Nunziata Rubino, Mariani Alberto, Petrone Maria Chiara, Fortunato Claudia, Falconi Massimo, Reni Michele, Arcidiacono Paolo Giorgio, Capurso Gabriele
Аннотация
BACKGROUND: Pancreatic adenocarcinoma (PDAC) presents with nonspecific symptoms, leading to long diagnostic delays and time-to-treatment. Data on the effects of diagnostic delay and time-to-treatment on the prognosis of PDAC patients are limited, dated and heterogeneous.
AIMS: To investigate whether diagnostic delay, time-to-treatment, or diagnostic delay + time-to-treatment (overall delay) impact overall survival (OS) and whether they differ in patients followed up at a tertiary referral center compared to community hospitals.
METHODS: This was a single-center prospective cohort of consecutive patients with PDAC, recording demographics, presenting symptoms, stage, treatments, and survival.
RESULTS: A total of 282 patients were included. Diagnostic delay>49 days was significantly associated with a higher risk of death in univariate (HR 1.627; 95 % CI 1.15-2.28; p = 0.005) but not in multivariate analysis, whereas overall delay>104 days was significantly associated with a higher risk of death in both univariate (HR 1.83; 95 %CI 1.29-2.61; p = 0.0008) and multivariate (HR, 1.63; 95 % CI, 1.13-2.34; p = 0.008) analyses. Patients who were entirely cared for in tertiary center presented a significantly shorter median time-to-treatment (49 vs. 56 days; p = 0.048) than those in community hospitals.
CONCLUSION: Prolonged diagnostic and overall delays seem to impair the survival of patients with PDAC. While diagnostic delay might be reduced with higher awareness of specific warning symptoms, the overall delay can be reduced through specific and faster dedicated therapeutic pathways in referral centers.
AIMS: To investigate whether diagnostic delay, time-to-treatment, or diagnostic delay + time-to-treatment (overall delay) impact overall survival (OS) and whether they differ in patients followed up at a tertiary referral center compared to community hospitals.
METHODS: This was a single-center prospective cohort of consecutive patients with PDAC, recording demographics, presenting symptoms, stage, treatments, and survival.
RESULTS: A total of 282 patients were included. Diagnostic delay>49 days was significantly associated with a higher risk of death in univariate (HR 1.627; 95 % CI 1.15-2.28; p = 0.005) but not in multivariate analysis, whereas overall delay>104 days was significantly associated with a higher risk of death in both univariate (HR 1.83; 95 %CI 1.29-2.61; p = 0.0008) and multivariate (HR, 1.63; 95 % CI, 1.13-2.34; p = 0.008) analyses. Patients who were entirely cared for in tertiary center presented a significantly shorter median time-to-treatment (49 vs. 56 days; p = 0.048) than those in community hospitals.
CONCLUSION: Prolonged diagnostic and overall delays seem to impair the survival of patients with PDAC. While diagnostic delay might be reduced with higher awareness of specific warning symptoms, the overall delay can be reduced through specific and faster dedicated therapeutic pathways in referral centers.