过去几十年，医疗保健的提供方式发生了重大变化。本研究分析了2004年至2020年头颈鳞癌（HNSCC）患者的临床流行病学因素和治疗模式。对来自2004年至2020年国家癌症数据库的HNSCC患者进行了回顾性队列分析。共纳入了164,290例患者。从2004年到2019年，所有设施类型（学术中心、AC；非学术中心、NAC）的确诊至手术治疗时间（TTS）都呈增加趋势，NAC受影响更大。TTS <15天（RR = 1.05，95%CI：1.05-1.09）和> 75天（1.07，95%CI：1.05-1.09）与增加的死亡风险相关。这种关联性在HPV + HNSCC中更为显著（RR = 1.45；95%CI：1.18-1.78）。在AC接受治疗与死亡风险降低相关（RR = 0.94，95%CI：0.93-0.95）。尽管从2004年到2019年等待时间普遍增加，但相对于2004-2007年，2016年至2019年的短期死亡率显著降低（3个月死亡率：RR = 0.77，95%CI：0.70-0.85；12个月死亡率：RR = 0.80，95%CI：0.77-0.84）。2020年等待时间减少。从2004年到2019年，TTS增加，NAC受影响更大。然而，尽管等待时间较长，短期生存率显著提高。非常短的（<15天）和非常长的（>75天）TTS与增加的死亡风险相关。接受治疗>75天的HPV + HNSCC患者增加最多。在AC接受治疗与存活率提高相关，这可能与AC拥有多学科团队和亚专业人员，而NAC的可用性较低有关。综合分析2020年等待时间需要2021年NCDB数据。版权所有©2023 Elsevier Ltd。保留所有权利。

The delivery of healthcare has changed significantly over the past decades. This study analyzes the clinicodemographic factors and treatment patterns of head and neck squamous cell carcinoma (HNSCC) patients between 2004 and 2020.Retrospective cohort analysis of HNSCC patients from the National Cancer Data Base from 2004 to 2020.A total of 164,290 patients were included. Increased times from diagnosis to definitive surgery (TTS) were seen across all facility types (academic centers, AC; non-academic centers, NAC) between 2004 and 2019, with NAC affected more. TTS < 15 days (RR = 1.05, 95%CI:1.05-1.09) and > 75 days (1.07, 95%CI:1.05-1.09) were associated with increased mortality risk. This association was more prominent among HPV + HNSCC (RR = 1.45; 95%CI:1.18-1.78). Treatment in AC was associated with a decreased mortality risk (RR = 0.94, 95%CI:0.93-0.95). Despite the universal increase in wait times from 2004 to 2019, short-term mortality was significantly decreased from 2016 to 2019, relative to 2004-2007 (3-month mortality: RR = 0.77, 95%CI:0.70-0.85; 12-month mortality: RR = 0.80, 95%CI:0.77-0.84). Wait times decreased in 2020.TTS increased between 2004 and 2019, with NAC affected more. However, despite longer wait times, short-term survival increased significantly. Very short (<15 days) and very long (>75 days) TTS were associated with increased mortality risk. Patients with HPV + HNSCC have the highest increase among those treated > 75 days from diagnosis. Treatment at AC was associated with improved survival, which could be explained by the presence of multidisciplinary teams and subspecialists that may be less available at NAC. The 2021 NCDB data are required for a comprehensive analysis of wait times in 2020.Copyright © 2023 Elsevier Ltd. All rights reserved.