Table 1.
Time to surgery (TTS).
| Author/Year [References] |
Country | Study Design | Study Period | No. of Patients | Median/ Mean Age |
End Point(s) | Findings |
|---|---|---|---|---|---|---|---|
| Time to Upfront Surgery (TTS-u) | |||||||
| Vanni G 2020 [9] |
Italy | Retrospective, COVID cohort vs. historical pre-COVID cohort | 2019–2020 | 432 | 62 | Breast cancer presentation | Increase in lymph node involvement in the COVID cohort |
| Bleicher RJ 2012 [15] | USA | Retrospective analysis of prospectively collected SEER data | 1992–2005 | 72,586 | 75 | Factors associated with delays between symptoms and surgery | Certain demographics and preoperative evaluation lead to greater TTS |
| Bleicher RJ 2016 [21] | USA | Two independent population-based analysis of prospectively collected SEER and NCDB data | 1992–2009 (SEER) 2003–2005 (NCDB) |
94,544 (SEER) 115,790 (NCDB) |
75.2 (SEER) 60.3 (NCDB) |
Effect of TTS on OS and DSS | Longer TTS is associated with lower OS and DSS |
| Eaglehouse YL 2019 [28] |
USA | Cross-sectional retrospective study using the U.S. Military Health System database | 1998–2010 | 9669 | 54.5 | All cause death | Longer TTS (≥36 days) associated with poorer OS |
| Polverini AC 2016 [29] |
USA | Retrospective analysis of prospectively collected NCDB data | 2004–2012 | 420,792 | 59.4 | Effect of TTS on OS | Longer TTS (≥8 weeks for stage I, >12 weeks for stage II) associated with decreased OS compared to TTS < 4 weeks |
| Mateo AM 2020 [30] | USA | Retrospective analysis of prospectively collected NCDB data | 2010–2014 | 351,087 | NA | OS for triple negative and other phenotypes | OS decreased for each month of delay by HR 1.104 for all phenotypes |
| Shin DW 2013 [31] |
Republic of Korea | Analysis of prospectively collected data | 2006–2011 | 7529 | 49.3 (for breast patients) | Effect of TTS on OS | TTS >12 weeks is associated with Increased mortality |
| Weiner AA 2023 [23] | USA | NCDB | 2010–2014 | 373,334 | 61 | Effect on OS | Compared to <4 weeks, surgery performed >8 weeks was associated with worse 5-year OS |
| Surgery following neoadjuvant therapy (TTS-n) | |||||||
| Sanford RA 2015 [22] | USA | Retrospective review of prospectively collected data | 1995–2007 | 1101 | NA | Effect of TTS (≤4, 4–6, >6 weeks) after NAC on OS | TTS after NAC up to 8 w has no effect on OS, RFS or LRFS. Worse OS if >8 weeks |
| Al-Masri M 2021 [26] | Jordan | Retrospective review | 2006–2014 | 468 | NA (65.4% ≤50-Y) | Effect of TTS (<4, 4–8, >8 weeks) after NAC on OS and DFS | TTS after NAC up to 8 w has no effect on OS or DFS. Worse OS if >8 w |
| Sutton TL 2020 [27] |
USA | Retrospective review of prospectively collected data | 2011–2017 | 463 | NA | Impact of TTS (≤4, 4–6, >6 weeks) after NAC on RFS, OS, DSS and RCB scores | TTS > 6 w associated with worse RFS and DSS, and a higher RCB score |
| Cullinane C 2021 [32] | Ireland | Systematic review and meta-analysis. Five studies met inclusion criteria | 8794 | 44–56 | Effect of TTS (<4, 4–8, >8 weeks) post-NAC on OS, DFS and pCR | TTS < 8 weeks associated with better OS and DFS compared to TTS > 8 weeks. Equivalent pCR between TTS < 4 w and 4–8 weeks | |
DFS: Disease-free survival; DSS: disease-specific survival; HR: hazard ratio; NAC: neoadjuvant chemotherapy; NCDB: National Cancer Database; OS: overall survival; RFS: relapse-free survival; pCR: pathological complete response; RCB: residual cancer burden; SEER: Surveillance Epidemiology and End Results; TNBC: triple-negative breast cancer; TTS: time to surgery; Yr: year.