Diagnostic delays are common among patients with hepatocellular carcinoma.
Diagnostic delays are common among patients with hepatocellular carcinoma.
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DOI：
10.6004/jnccn.2015.0074
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发表时间：
2015-05
期刊：
影响因子：
--
通讯作者：
Singal AG
中科院分区：
文献类型：
--
作者：
Patel N;Yopp AC;Singal AG
大多数肝细胞癌（HCC）患者出现在晚期。HCC患者诊断评估延迟的发生率和临床影响尚不清楚。识别和描述与HCC患者诊断延迟相关的因素。我们回顾了2005年1月至2012年7月期间在一家大型城市医院连续治疗的肝硬化和HCC患者的记录。采用Kaplan-Meier分析确定从出现到诊断的时间。诊断延迟定义为诊断时间超过3个月，多变量logistic回归用于确定诊断延迟的相关因素。在457例HCC患者中，226例（49.5%）在门诊诊断。其中，中位诊断时间为2.2个月，87例患者（38.5%）出现诊断延迟。诊断延迟与肝性脑病的存在呈正相关（比值比[OR]，2.29; 95%CI，1.03-5.07），与实施电子病历（EMR）后的表现呈负相关多变量分析显示，患者的OR值为0.28; 95%CI为0.15-0.52，超声检查异常的OR值为0.36; 95%CI为0.19-0.67。在肝性脑病患者中观察到较高的诊断延迟率（56% vs 35%），而在EMR实施后出现的患者（26% vs 60%）和出现异常超声伴或不伴甲胎蛋白水平升高的患者（27% vs 50%）中观察到较低的诊断延迟率。在49例肿块形成型HCC和诊断延迟的患者中，18%的患者肿瘤生长间隔≥ 2 cm。近20%的HCC患者从就诊到诊断等待时间超过3个月，这可能导致肿瘤间隔生长。
Most patients with hepatocellular carcinoma (HCC) present at advanced stages. The prevalence and clinical impact of delays during diagnostic evaluation among patients with HCC is unclear. To identify and characterize factors associated with diagnostic delays among patients with HCC. Records were reviewed for consecutive patients with cirrhosis and HCC at a large urban hospital between January 2005 and July 2012. Time from presentation to diagnosis was determined using Kaplan-Meier analysis. Diagnostic delay was defined as time to diagnosis exceeding 3 months, and multivariate logistic regression was used to identify correlates of diagnostic delays. Among 457 patients with HCC, 226 (49.5%) were diagnosed as outpatients. Among these, median time-to-diagnosis was 2.2 months, with 87 patients (38.5%) experiencing a diagnostic delay. Diagnostic delays were positively associated with the presence of hepatic encephalopathy (odds ratio [OR], 2.29; 95% CI, 1.03–5.07) and negatively associated with presentation after implementation of the electronic medical records (EMR) (OR, 0.28; 95% CI, 0.15–0.52) and presentation with an abnormal ultrasound (OR, 0.36; 95% CI, 0.19–0.67) on multivariate analysis. Higher rates of diagnostic delays were observed among those with hepatic encephalopathy (56% vs 35%), whereas lower rates were seen in those who presented after EMR implementation (26% vs 60%) and those who presented with an abnormal ultrasound with or without an elevated alpha fetoprotein level (27% vs 50%). Among 49 patients with mass-forming HCC and diagnostic delay, 18% had interval tumor growth of 2 cm or greater. Nearly 20% of patients with HCC wait more than 3 months from presentation to diagnosis, which can contribute to interval tumor growth.
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