title: Impact of diagnosis-to-treatment waiting time on survival in esophageal cancer patients - A population-based study in The Netherlands.
abstract: BACKGROUND
  The aim of this study was to determine whether the waiting time from diagnosis to treatment with curative intent for esophageal cancer impacts oncologic outcomes.
  
  
  METHODS
  All patients treated by esophagectomy for esophageal carcinoma in 2005-2013 were identified from the Netherlands Cancer Registry. Patients who underwent multimodality treatment and patients treated with surgery only were analyzed separately. Multivariable logistic regression analyses were performed to evaluate the impact of diagnosis-to-treatment waiting time on pT-status, pN-status, and R0 resection rates. Cox regression was applied to estimate the influence of waiting time on overall survival. Analyses were performed with the original scale and in three categorized groups of waiting time (≤5 weeks, 5-8 weeks, and >8 weeks) based on guidelines and previous studies.
  
  
  RESULTS
  Of 3839 patients, 2589 underwent multimodality treatment and 1250 were treated with surgery only. In both groups, pT-status, pN-status, and R0 resection rates were not significantly influenced by waiting time (p-values >0.05). Also, waiting time was not significantly associated with overall survival in the multimodality treatment group (5-8 weeks vs. ≤5 weeks, hazard ratio [HR] 1.12, p = 0.171; and >8 weeks vs. ≤5 weeks, HR 1.21, p = 0.167), nor in the surgery only group (5-8 weeks vs. ≤5 weeks, HR 0.92, p = 0.432; and >8 weeks vs. ≤5 weeks, HR 1.00, p = 0.973).
  
  
  CONCLUSIONS
  This large population-based cohort study demonstrates that longer waiting time from diagnosis to treatment in patients treated for esophageal cancer with curative intent does not negatively impact pT-status, pN-status, R0 resection rates, and overall survival.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands. Electronic address: E.Visser-3@umcutrecht.nl.
authors.forename: E
authors.initials: E
authors.lastname: Visser
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands; Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
authors.forename: P S N
authors.initials: PS
authors.lastname: van Rossum
authors.affiliation: Center for Healthcare Operations Improvement and Research, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands; UMC Utrecht Cancer Center, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
authors.forename: A G
authors.initials: AG
authors.lastname: Leeftink
authors.affiliation: Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Hoedemakerplein 2, 7511 JP, Enschede, The Netherlands; Department of Health Technology and Services Research, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Siesling
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: van Hillegersberg
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands. Electronic address: J.P.Ruurda@umcutrecht.nl.
authors.forename: J P
authors.initials: JP
authors.lastname: Ruurda
mesh_terms: D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands; D011379:Prognosis; D012042:Registries; D015996:Survival Rate; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Esophageal cancer; Outcome; Prognosis; Survival; Waiting time