Emergency presentation of cancer and short-term mortality.
Emergency presentation of cancer and short-term mortality.
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DOI：
10.1038/bjc.2013.569
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发表时间：
2013-10-15
影响因子：
8.8
通讯作者：
Richards, M.
中科院分区：
文献类型：
--
作者：
McPhail, S.;Elliss-Brookes, L.;Shelton, J.;Ives, A.;Greenslade, M.;Vernon, S.;Morris, E. J. A.;Richards, M.
英国癌症诊断后的短期生存率低于同类国家，超额死亡率的差异主要发生在诊断后的几个月内。我们评估了诊断后一年内紧急就诊（EP）对英格兰超额死亡率的影响。包括 2006 年至 2008 年在英格兰出现的所有结直肠癌和宫颈癌以及英格兰东部的所有乳腺癌、肺癌和前列腺癌。对 EP 可能性随年龄、阶段、性别、共病和收入剥夺的变化进行了建模。然后检查诊断后 0-1、1-3、3-6 和 6-12 个月内的超额死亡率及其对这些病例组合因素和发病途径的依赖性。晚期阶段和年龄较大是 EP 的预测因素，而共病、较高的收入剥夺和女性性别在较小程度上也是 EP 的预测因素。在诊断后的第一个月，我们观察到与非 EP 相比，经病例组合调整的 EP 的超额死亡率比为 7.5（宫颈）、5.9（结直肠）、11.7（乳腺癌）、4.0（肺）和 20.8（前列腺）。与非 EP 患者相比，急诊患者在所有检查的癌症类型中短期死亡率都较高。这在一定程度上是病例组合效应，但即使考虑了年龄、分期和合并症，EP 仍然可以预测短期死亡率。
The short-term survival following a cancer diagnosis in England is lower than that in comparable countries, with the difference in excess mortality primarily occurring in the months immediately after diagnosis. We assess the impact of emergency presentation (EP) on the excess mortality in England over the course of the year following diagnosis. All colorectal and cervical cancers presenting in England and all breast, lung, and prostate cancers in the East of England in 2006–2008 are included. The variation in the likelihood of EP with age, stage, sex, co-morbidity, and income deprivation is modelled. The excess mortality over 0–1, 1–3, 3–6, and 6–12 months after diagnosis and its dependence on these case-mix factors and presentation route is then examined. More advanced stage and older age are predictive of EP, as to a lesser extent are co-morbidity, higher income deprivation, and female sex. In the first month after diagnosis, we observe case-mix-adjusted excess mortality rate ratios of 7.5 (cervical), 5.9 (colorectal), 11.7 (breast ), 4.0 (lung), and 20.8 (prostate) for EP compared with non-EP. Individuals who present as an emergency experience high short-term mortality in all cancer types examined compared with non-EPs. This is partly a case-mix effect but EP remains predictive of short-term mortality even when age, stage, and co-morbidity are accounted for.
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影响因子：
8.8
作者：
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通讯作者：
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