{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:38:18Z","timestamp":1786581498118,"version":"build-2736575974"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,10,28]],"date-time":"2024-10-28T00:00:00Z","timestamp":1730073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>The delays in cancer therapies have the potential to impact disease progression by allowing the unchecked growth and spread of cancer cells. However, the understanding of the association between treatment waiting time and survival outcomes in patients with esophageal cancer (EC) is limited. This study aims to assess the impact of waiting time on survival outcomes among EC patients in Hebei province, which is recognized as one of the high-risk areas for EC in China.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 9,977 non-metastatic EC patients who underwent surgical treatment were identified between 2000 and 2020. The survival outcomes of overall survival (OS) and cancer-specific survival (CSS) were determined using the Kaplan-Meier methodology. Univariate and multivariate Cox regression analysis was employed to evaluate the impact of treatment delays on OS and CSS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The average delay time for initiating EC surgical treatment after diagnosis was 1.31 months (95%CI=1.29\u20131.34). Patients with a long delay (\u2265 3 months) in\u00a0treatment, comprising 9977 EC patients, exhibited significantly lower rates of 3-, 5-, and 10-year OS and CSS compared to those without any delay in treatment initiation. A long delay in EC treatment independently associated with an elevated risk of all-cause and cancer-cause mortality among various patient subgroups, including males, older individuals, single individuals, low-income patients, residents of nonmetropolitan counties, as well as those diagnosed with poorly differentiated and stage IV EC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The long delay of treatment initiation impacts the outcomes of OS and CSS in EC patients. Optimizing treatment timing may enhance life expectancy for individuals diagnosed with EC.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2024.1463517","type":"journal-article","created":{"date-parts":[[2024,10,28]],"date-time":"2024-10-28T06:10:32Z","timestamp":1730095832000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Association between surgery treatment delays and survival outcomes in patients with esophageal cancer in Hebei, China"],"prefix":"10.3389","volume":"14","author":[{"given":"Xing","family":"Cui","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunxiao","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jidong","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,10,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2021.6987","article-title":"Cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life years for 29 cancer groups from 2010 to 2019: A systematic analysis for the global burden of disease study 2019","volume":"8","year":"2022","journal-title":"JAMA Oncol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1186\/s13045-021-01213-z","article-title":"Global, regional, and national cancer incidence and death for 29 cancer groups in 2019 and trends analysis of the global cancer burden, 1990-2019","volume":"14","author":"Lin","year":"2021","journal-title":"J Hematol Oncol"},{"key":"B4","unstructured":"Global health estimates: leading causes of death. Cause-specific mortality, 2000\u20132019"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(20)30007-8","article-title":"The global, regional, and national burden of oEC and its attributable risk factors in 195 countriesand territories, 1990-2017: a systematic analysis for the global burden of disease study 2017","volume":"5","year":"2020","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn112152-20240119-00035","article-title":"Cancer incidence and mortality in China, 2022","volume":"46","author":"Zheng","year":"2024","journal-title":"Zhonghua Zhong Liu Za Zhi"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3978\/j.issn.1000-9604.2015.10.06","article-title":"Incidence and mortality rate of esophageal cancer has decreased during past 40 years in Hebei Province, China","volume":"27","author":"He","year":"2015","journal-title":"Chin J Cancer Res"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-021-09911-1","article-title":"Impact of race\/ethnicity and county-level vulnerability on receipt of surgery among older medicare beneficiaries with the diagnosis of early pancreatic cancer","volume":"28","author":"Azap","year":"2021","journal-title":"Ann Surg Oncol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e069008","DOI":"10.1136\/bmj-2021-069008","article-title":"Association of computed tomography screening with lung cancer stage shift and survival in the United States: quasi-experimental study","volume":"376","author":"Potter","year":"2022","journal-title":"BMJ"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1200\/OP.21.00485","article-title":"Impact of diagnostic delays on lung cancer survival outcomes: A population study of the US SEER-medicare database","volume":"18","author":"Romine","year":"2022","journal-title":"JCO Oncol Pract"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.canep.2015.06.005","article-title":"Guideline-concordant timely lung cancer care and prognosis among elderly patients in the United States: A population-based study","volume":"39","author":"Nadpara","year":"2015","journal-title":"Cancer Epidemiol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1007\/s10552-013-0172-6","article-title":"Do diagnostic and treatment delays for colorectal cancer increase risk of death","volume":"24","author":"Pruitt","year":"2013","journal-title":"Cancer Causes Control"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2019.03.244","article-title":"Time to surgery and its impact on survival in patients with endometrial cancer: a national cancer database study","volume":"153","author":"AlHilli","year":"2019","journal-title":"Gynecol Oncol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e0199532","DOI":"10.1371\/journal.pone.0199532","article-title":"Infuence of the time interval from diagnosis to treatment on survival for early-stage liver cancer","volume":"13","author":"Tsai","year":"2018","journal-title":"PloS One"},{"key":"B15","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1186\/s12967-022-03719-7","article-title":"Survival outcomes following treatment delays among patients with early-stage female cancers: a nationwide study","volume":"20","author":"Min","year":"2022","journal-title":"J\u00a0Transl Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"m4087","DOI":"10.1136\/bmj.m4087","article-title":"Mortality due to cancer treatment delay: systematic review and meta-analysis","volume":"371","author":"Hanna","year":"2020","journal-title":"BMJ"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2019-0057","article-title":"Delays and barriers to cancer care in low- and middle-income countries: a systematic review","volume":"24","author":"Brand","year":"2019","journal-title":"Oncologist"},{"key":"B18","doi-asserted-by":"publisher","first-page":"S92","DOI":"10.1038\/bjc.2015.48","article-title":"Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review","volume":"112","author":"Neal","year":"2015","journal-title":"Br J Cancer"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e318211cc0f","article-title":"Wait times for cancer surgery in the United States: trends and predictors of delays","volume":"253","author":"Bilimoria","year":"2011","journal-title":"Ann Surg"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2017.0027","article-title":"Cancer treatment delays in american Indians and alaska natives enrolled in medicare","volume":"28","author":"Adams","year":"2017","journal-title":"J Health Care Poor Underserved"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.30072","article-title":"Assessment of time-to-treatment initiation and survival in a cohort of patients with common cancers","volume":"3","author":"Cone","year":"2020","journal-title":"JAMA Netw Open"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0213209","article-title":"Time to initial cancer treatment in the United States and association with survival over time: An observational study","volume":"14","author":"Khorana","year":"2019","journal-title":"PloS One"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-016-5191-6","article-title":"Waiting Time from Diagnosis to Treatment has no Impact on Survival in Patients with Esophageal Cancer","volume":"23","author":"Visser","year":"2016","journal-title":"Ann Surg Oncol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2016.10.017","article-title":"Impact of diagnosis-to-treatment waiting time on survival in esophageal cancer patients-A population-based study in The Netherlands","volume":"43","author":"Visser","year":"2017","journal-title":"Eur J Surg Oncol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6603333","article-title":"Do delays between diagnosis and surgery in resectable oesophageal cancer affect survival? A study based on West Midlands cancer registration data","volume":"95","author":"Kotz","year":"2006","journal-title":"Br J Cancer"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.xjon.2022.08.004","article-title":"Time to treatment of esophageal cancer in Ontario: A population-level cross-sectional study","volume":"12","author":"Hanna","year":"2022","journal-title":"JTCVS Open"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-009-1109-y","article-title":"Delay in diagnostic workup and treatment of esophageal cancer","volume":"14","author":"Grotenhuis","year":"2010","journal-title":"J Gastrointest Surg"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.14423\/SMJ.0000000000001226","article-title":"Esophageal cancer: an updated review","volume":"114","author":"DiSiena","year":"2021","journal-title":"South Med J"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1093\/advances\/nmac087","article-title":"Diet and esophageal cancer risk: an umbrella review of systematic reviews and meta-analyses of observational studies","volume":"13","author":"Qin","year":"2022","journal-title":"Adv Nutr"},{"key":"B30","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3322\/caac.21708","article-title":"Cancer statistics, 2022","volume":"72","author":"Siegel","year":"2022","journal-title":"CA Cancer J Clin"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.2950","article-title":"Differences in stage of cancer at diagnosis, treatment, and survival by race and ethnicity among leading cancer types","volume":"3","author":"Zhang","year":"2020","journal-title":"JAMA Netw Open"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2018.03.001","article-title":"Stage-specific incidence rates and trends of prostate cancer by age, race, and ethnicity, United States, 2004-2014","volume":"28","author":"Li","year":"2018","journal-title":"Ann Epidemiol"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-19-1344","article-title":"Racial\/ethnic disparities in prostate cancer incidence, distant stage diagnosis, and mortality by U.S. Census region and age group, 2012-2015","volume":"29","author":"Iyengar","year":"2020","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2014.08.001","article-title":"Prediagnostic self-assessed health and extent of social networks predict survival in older individuals with cancer: a population based cohort study","volume":"5","author":"Rottenberg","year":"2014","journal-title":"J Geriatr Oncol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.31263","article-title":"Satisfaction with cancer care, self-efficacy, and health-related quality of life in Latino cancer survivors","volume":"124","author":"Moreno","year":"2018","journal-title":"Cancer"},{"key":"B36","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1080\/02841860701418846","article-title":"Research in Danish cancer rehabilitation: social characteristics and late effects of cancer among participants in the FOCARE research project","volume":"47","author":"H\u00f8ybye","year":"2008","journal-title":"Acta Oncol"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1007\/s11764-010-0139-5","article-title":"Social networks and survival after breast cancer diagnosis","volume":"4","author":"Beasley","year":"2010","journal-title":"J Cancer Surviv"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-012-1962-3","article-title":"Social networks, social support and burden in relationships, and mortality after breast cancer diagnosis","volume":"133","author":"Kroenke","year":"2012","journal-title":"Breast Cancer Res Treat"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1002\/pon.4059","article-title":"Post-diagnosis social networks, and lifestyle and treatment factors in the After Breast Cancer Pooling Project","volume":"26","author":"Kroenke","year":"2017","journal-title":"Psychooncology"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-005-3702-4","article-title":"The influence of marital status on the stage at diagnosis, treatment, and survival of older women with breast cancer","volume":"93","author":"Osborne","year":"2005","journal-title":"Breast Cancer Res Treat"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-019-05119-y","article-title":"Multilevel determinants of financial toxicity in breast cancer care: perspectives of healthcare professionals and Latina survivors","volume":"28","author":"Chebli","year":"2020","journal-title":"Support Care Cancer"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1777","DOI":"10.1097\/01.ju.0000177521.72678.61","article-title":"Treatment delay and prognosis in invasive bladder cancer","volume":"174","author":"Liedberg","year":"2005","journal-title":"J Urol"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.v110:4","article-title":"Diagnosis delays in childhood cancer: a review","volume":"110","author":"Dang-Tan","year":"2007","journal-title":"Cancer"},{"key":"B44","doi-asserted-by":"publisher","first-page":"4914","DOI":"10.1038\/s41598-021-84162-4","article-title":"Delay to surgical treatment in lung cancer patients and its impact on survival in a video-assisted thoracoscopic lobectomy cohort","volume":"11","author":"Ponholzer","year":"2021","journal-title":"Sci Rep"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.314.7079.467","article-title":"Delays in the diagnosis of oesophagogastric cancer: a consecutive case series","volume":"314","author":"Martin","year":"1997","journal-title":"BMJ"},{"key":"B46","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1093\/jjco\/hym169","article-title":"The symptom-to-treatment delay and stage at the time of treatment in cancer of esophagus","volume":"38","author":"Wang","year":"2008","journal-title":"Jpn J Clin Oncol"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1016\/0959-8049(94)00252-z","article-title":"In vivo cell kinetic measurements in human oesophageal cancer: what can be learned from multiple biopsies","author":"Haustermans","year":"1994","journal-title":"Eur J Cancer"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(196111\/12)14:6<1272::AID-CNCR2820140618>3.0.CO;2-H","article-title":"A biomathematical approach to clinical tumor growth","volume":"14","author":"Schwartz","year":"1961","journal-title":"Cancer"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2024.1463517\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,28]],"date-time":"2024-10-28T06:10:36Z","timestamp":1730095836000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2024.1463517\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,28]]},"references-count":48,"alternative-id":["10.3389\/fonc.2024.1463517"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2024.1463517","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,28]]},"article-number":"1463517"}}