title: Waiting Time from Diagnosis to Treatment has no Impact on Survival in Patients with Esophageal Cancer.
abstract: Waiting time from diagnosis to treatment has emerged as an important quality indicator in cancer care. This study was designed to determine the impact of waiting time on long-term outcome of patients with esophageal cancer who are treated with neoadjuvant therapy followed by surgery or primary surgery.
  
  
  
  Patients who underwent esophagectomy for esophageal cancer at the University Medical Center Utrecht between 2003 and 2014 were included. Patients treated with neoadjuvant therapy followed by surgery and treated with primary surgery were separately analyzed. The influence of waiting time on survival was analyzed using Cox proportional hazard analyses. Kaplan-Meier curves for short (<8 weeks) and long (≥8 weeks) waiting times were constructed.
  
  
  
  A total of 351 patients were included; 214 received neoadjuvant treatment, and 137 underwent primary surgery. In the neoadjuvant group, the waiting time had no impact on disease-free survival (DFS) [hazard ratio (HR) 0.96, 95 % confidence interval (CI) 0.88-1.04; p = 0.312] or overall survival (OS) (HR 0.96, 95 % CI 0.88-1.05; p = 0.372). Accordingly, no differences were found between neoadjuvantly treated patients with waiting times of <8 and ≥8 weeks in terms of DFS (p = 0.506) and OS (p = 0.693). In the primary surgery group, the waiting time had no impact on DFS (HR 1.03, 95 % CI 0.95-1.12; p = 0.443) or OS (HR 1.06, 95 % CI 0.99-1.13; p = 0.108). Waiting times of <8 weeks versus ≥8 weeks did not result in differences regarding DFS (p = 0.884) or OS (p = 0.374).
  
  
  
  In esophageal cancer patients treated with curative intent by either neoadjuvant therapy followed by surgery or primary surgery, waiting time from diagnosis to treatment has no impact on long-term outcome.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, GA, Utrecht, The Netherlands. e.visser-3@umcutrecht.nl.
authors.forename: E
authors.initials: E
authors.lastname: Visser
authors.affiliation: Center for Healthcare Operations Improvement and Research, University of Twente, Enschede, The Netherlands.|UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: A G
authors.initials: AG
authors.lastname: Leeftink
authors.affiliation: Department of Surgery, University Medical Center Utrecht, GA, Utrecht, The Netherlands.|Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: P S N
authors.initials: PS
authors.lastname: van Rossum
authors.affiliation: Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Amsterdam, The Netherlands.|Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Siesling
authors.affiliation: Department of Surgery, University Medical Center Utrecht, GA, Utrecht, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: van Hillegersberg
authors.affiliation: Department of Surgery, University Medical Center Utrecht, GA, Utrecht, The Netherlands. j.p.ruurda@umcutrecht.nl.
authors.forename: J P
authors.initials: JP
authors.lastname: Ruurda
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D016629:Esophagectomy / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D061665:Time-to-Treatment; D016896:Treatment Outcome