title: Association between the diagnosis-to-treatment interval and overall survival in Taiwanese patients with oral cavity squamous cell carcinoma.
abstract: To investigate the association between the diagnosis-to-treatment interval (DTI) and overall survival (OS) in patients with oral cavity squamous cell carcinoma (OSCC).
  
  
  
  A total of 18,677 patients with first primary OSCC identified in the Taiwanese Cancer Registry Database between 2004 and 2010 were examined. The effect of DTI on 5-year OS rates was investigated with multivariate Cox regression analysis. After the identification of the optimal cutoff for DTI based on the 5-year OS rates, DTI was classified in the following 20-day groups: ≤20 days (57% of the study patients), 21-45 days (34%), 46-90 days (6%) and ≥91 days (3%). In additional exploratory analyses, DTI was reclassified in the following 30-day interval groups: ≤30 days (81% of the study patients), 31-60 days (14%), 61-90 days (2%) and ≥91 days (3%).
  
  
  
  Multivariate analyses identified DTI (≤20 days versus other subgroups), sex (female versus male), age (<65 versus ≥65 years), clinical stage (p-stage I versus p-stage II, III, IV) and treatment modality (initial surgery versus initial non-surgery) as independent prognostic factors for 5-year OS. Compared with a DTI ≤20 days, the DTI categories ≥91 days (hazard ratio [HR]: 1.28, P < 0.001), 46-90 days (HR: 1.25, P < 0.001) and 21-45 days (HR: 1.07, P = 0.007) were independently associated with a higher risk of 5-year mortality. Similar results were obtained for DTI ≤30 days groups.
  
  
  
  DTI is independently associated with 5-year OS in OSCC patients. A DTI longer than 30 days or even 20 days may potentially decrease survival.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chun-Ta
authors.initials: CT
authors.lastname: Liao
authors.affiliation: Nursing Department, Chang Gung Memorial Hospital and School of Nursing, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Hsin-Ni
authors.initials: HN
authors.lastname: Chen
authors.affiliation: Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yu-Wen
authors.initials: YW
authors.lastname: Wen
authors.affiliation: Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Shu Ru
authors.initials: SR
authors.lastname: Lee
authors.affiliation: Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
authors.forename: Shu-Hang
authors.initials: SH
authors.lastname: Ng
authors.affiliation: National Institute of Cancer Research, National Health Research Institutes, Taiwan.
authors.forename: Tsang-Wu
authors.initials: TW
authors.lastname: Liu
authors.affiliation: Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan.
authors.forename: Sen-Tien
authors.initials: ST
authors.lastname: Tsai
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, China Medical University Hospital, Taiwan.
authors.forename: Ming-Hsui
authors.initials: MH
authors.lastname: Tsai
authors.affiliation: Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Jin-Ching
authors.initials: JC
authors.lastname: Lin
authors.affiliation: Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
authors.forename: Pei-Jen
authors.initials: PJ
authors.lastname: Lou
authors.affiliation: Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
authors.forename: Cheng Ping
authors.initials: CP
authors.lastname: Wang
authors.affiliation: Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Pen-Yuan
authors.initials: PY
authors.lastname: Chu
authors.affiliation: Department of Otolaryngology, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Yi-Shing
authors.initials: YS
authors.lastname: Leu
authors.affiliation: Department of Oral and Maxillofacial Surgery, Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Kuo-Yang
authors.initials: KY
authors.lastname: Tsai
authors.affiliation: Department of Head and Neck Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
authors.forename: Shyuang-Der
authors.initials: SD
authors.lastname: Terng
authors.affiliation: Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
authors.forename: Tsung-Ming
authors.initials: TM
authors.lastname: Chen
authors.affiliation: Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors.forename: Cheng-Hsu
authors.initials: CH
authors.lastname: Wang
authors.affiliation: Department of Otolaryngology, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan.
authors.forename: Chih-Yen
authors.initials: CY
authors.lastname: Chien
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: Wen-Cheng
authors.initials: WC
authors.lastname: Chen
authors.affiliation: Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
authors.forename: Li-Yu
authors.initials: LY
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chien-Yu
authors.initials: CY
authors.lastname: Lin
authors.affiliation: Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
authors.forename: Hung-Ming
authors.initials: HM
authors.lastname: Wang
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Lin
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
authors.forename: Tuan-Jen
authors.initials: TJ
authors.lastname: Fang
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
authors.forename: Shiang-Fu
authors.initials: SF
authors.lastname: Huang
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chung-Jan
authors.initials: CJ
authors.lastname: Kang
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
authors.forename: Kai-Ping
authors.initials: KP
authors.lastname: Chang
authors.affiliation: Biostatistics and Informatics Unit, Clinical Trial Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. Electronic address: lyyang0111@gmail.com.
authors.forename: Lan Yan
authors.initials: LY
authors.lastname: Yang
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. Electronic address: yentc1110@gmail.com.
authors.forename: Tzu-Chen
authors.initials: TC
authors.lastname: Yen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000628:therapy*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality* / Q000628:therapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Cancer database; Diagnosis to treatment interval; Oral cavity squamous cell carcinoma; Outcome; Treatment delay