title: Longer waiting times for early stage cervical cancer patients undergoing radical hysterectomy are associated with diminished long-term overall survival.
abstract: OBJECTIVE
  The aim of this study was to evaluate the impact of surgical waiting time on clinical outcome in early stage cervical cancer.
  
  
  METHODS
  The cohort consisted of 441 patients diagnosed with stages IA2-IB1cervical cancer who underwent radical hysterectomy and pelvic node dissection. The patients were divided into two groups based on surgical waiting time. The associations between waiting time and other potential prognostic factors with clinical outcome were evaluated.
  
  
  RESULTS
  The median surgical waiting time was 43 days. Deep stromal invasion (hazard ratio [HR], 2.5; 95% confidence interval [CI], 1.4 to 4.6; p=0.003) and lymph node metastasis (HR, 2.9; 95% CI, 1.3 to 6.7; p=0.026) were identified as independent prognostic factors for recurrence-free survival while no prognostic significance of surgical waiting time was found (p=0.677). On multivariate analysis of overall survival (OS), only deep stromal invasion (HR, 2.6; 95% CI, 1.3 to 5.0; p=0.009) and lymph node metastasis (HR, 3.6; 95% CI, 1.5 to 8.6; p=0.009) were identified as independent prognostic factors for OS. Although OS showed no significant difference between short (≤ 8 weeks) and long (>8 weeks) waiting times, multivariate analysis of OS with time-varying effects revealed that a waiting time longer than 8 weeks was associated with poorer long-term survival (after 5 years; HR, 3.4; 95% CI, 1.3 to 9.2; p=0.021).
  
  
  CONCLUSIONS
  A longer surgical waiting time was associated with diminished long-term OS of early stage cervical cancer patients.
authors.affiliation: Department of Obstetrics and Gynecology, Prince of Songkla University Faculty of Medicine, Songkhla, Thailand.
authors.forename: Kulisara
authors.initials: K
authors.lastname: Nanthamongkolkul
authors.affiliation: Department of Obstetrics and Gynecology, Prince of Songkla University Faculty of Medicine, Songkhla, Thailand. hjitti@yahoo.com.
authors.forename: Jitti
authors.initials: J
authors.lastname: Hanprasertpong
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D061665:Time-to-Treatment; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*
keywords: Prognosis; Radical Hysterectomy; Uterine Cervical Neoplasms; Waiting Time