Background National targets for timely diagnosis and management of a potential cancer are driven in part by the perceived risk of disease progression during avoidable delays. However, it is unclear to what extent time-to-treatment impacts prognosis for patients with non-small cell lung cancer, with previous reviews reporting mixed or apparently paradoxical associations. This systematic review focuses on potential confounders in order to identify particular patient groups which may benefit most from timely delivery of care. Methods Medline, EMBASE and Cochrane databases were searched for publications between January 2012 and October 2020, correlating timeliness in secondary care pathways to patient outcomes. The protocol is registered with PROSPERO (the International Prospective Register of Systematic Reviews; ID 99239). Prespecified factors (demographics, performance status, histology, stage and treatment) are examined through narrative synthesis. Results Thirty-seven articles were included. All but two were observational. Timely care was generally associated with a worse prognosis in those with advanced stage disease (6/8 studies) but with better outcomes for patients with early-stage disease treated surgically (9/12 studies). In one study, patients with squamous cell carcinoma referred for stereotactic ablative radiotherapy benefited more from timely care, compared with patients with adenocarcinoma. One randomised controlled trial supported timeliness as being advantageous in those with stage I–IIIA disease. Conclusion There are limitations to the available evidence, but observed trends suggest timeliness to be of particular importance in surgical candidates. In more advanced disease, survival trends are likely outweighed by symptom burden, performance status or clinical urgency dictating timeliness of treatment. All data relevant to the study are included in the article or uploaded as supplementary information.

中文翻译：

---

非小细胞肺癌治疗时间与结果之间的关联：系统评价


背景 及时诊断和管理潜在癌症的国家目标部分是由在可避免的延误期间疾病进展的感知风险驱动的。然而，尚不清楚治疗时间在多大程度上影响非小细胞肺癌患者的预后，之前的评论报告了混合或明显矛盾的关联。本系统评价重点关注潜在的混杂因素，以确定可能从及时提供护理中获益最多的特定患者群体。方法 检索了 Medline、EMBASE 和 Cochrane 数据库中 2012 年 1 月至 2020 年 10 月期间发表的出版物，将二级护理途径的及时性与患者结果相关联。该方案已在 PROSPERO（国际系统评价前瞻性登记册；ID 99239）注册。通过叙述综合来检查预先指定的因素（人口统计、表现状态、组织学、阶段和治疗）。结果 纳入 37 篇文章。除两人外，其余所有人均处于观察状态。及时护理通常与晚期疾病患者的预后较差相关（6/8 研究），但对于接受手术治疗的早期疾病患者来说，预后较好（9/12 研究）。在一项研究中，与腺癌患者相比，转诊接受立体定向消融放射治疗的鳞状细胞癌患者从及时护理中获益更多。一项随机对照试验支持及时性对于 I-IIIA 期疾病患者是有利的。结论 现有证据存在局限性，但观察到的趋势表明，及时性对于手术候选者尤为重要。 在更晚期的疾病中，症状负担、表现状态或决定治疗及时性的临床紧迫性可能会超过生存趋势。与研究相关的所有数据都包含在文章中或作为补充信息上传。