Impact of Time to Surgery on Long-Term Survival Outcomes in Patients with Non-Metastatic Breast Cancer

Abstract

Objective: To investigate the association between time to surgery and 5-year overall survival and 5-year disease-free survival in patients with AJCC stage 1–3 breast cancer

Methods: A retrospective study was conducted on 477 patients treated at Nakhonpathom Hospital (2017–2021). Patients was categorized into four groups depended on waiting time to surgery: less than 4, 4–6, 6–8, and more than 8 weeks. Survival analysis for overall survival and disease-free survival was performed using Kaplan-Meier and multivariate Cox regression models to evaluate prognostic factors.

          Results: The 5-year overall survival rates were comparable among patients with a surgical waiting time of less than 4, 4–6, and 6–8 weeks (83.8%, 81.9%, and 80.9%, respectively). However, survival significantly decreased to 62.7% in patients waiting more than 8 weeks (p = .003). Similarly, the 5-year disease-free survival rate declined to 54.9% in this group (p < .001). Multivariate analysis demonstrated that a surgical waiting time exceeding 8 weeks was an independent risk factor associated with increased mortality (HR = 1.792; 95% CI: 1.014–3.166; p = .045). Other independent risk factors associated with poor overall survival and disease-free survival included stage III disease, triple-negative breast cancer, and HER2 overexpression.

Conclusion: A surgical delay beyond 8 weeks significantly compromises both overall survival and disease-free survival. Healthcare service optimization to ensure surgical intervention within this optimum window serves as a critical systemic factor to improve clinical outcomes.