Evidence of advanced stage colorectal cancer with longer diagnostic intervals: a pooled analysis of seven primary care cohorts comprising 11 720 patients in five countries.
Evidence of advanced stage colorectal cancer with longer diagnostic intervals: a pooled analysis of seven primary care cohorts comprising 11 720 patients in five countries.
复制标题
DOI：
10.1038/bjc.2017.236
复制
发表时间：
2017-09-05
影响因子：
8.8
通讯作者：
Rubin G
中科院分区：
文献类型：
--
作者：
Tørring ML;Murchie P;Hamilton W;Vedsted P;Esteva M;Lautrup M;Winget M;Rubin G
症状性癌症快速诊断的益处尚不确定。我们的目的是分析结直肠癌（CRC）分期与诊断间隔的初级和专科护理组成部分之间的关系。我们从1997-2010年期间在苏格兰、英格兰、加拿大、丹麦和西班牙进行的基于人群的研究中确定了7个独立的数据集，共有11720例新诊断的CRC患者，他们最初向初级保健医生提出了症状。数据分别从患者记录、登记、稽查和问卷中提取。要求数据集包含诊断间隔日期（定义为从初级保健首次出现症状到诊断日期的时间）、初级保健首次出现症状、转诊途径、性别、年龄和组织学确认的分期的信息。我们对所有个体数据集进行了重新分析，并使用相同的方法分析了合并的个体患者数据集。在个体和合并数据集中，间期和分期之间的相关性相似。初级保健间隔和晚期（即，远端或区域性）而不是局限性CRC（P=0.004），从第一天开始，几率开始增加，并在90天达到峰值。对于专科治疗，我们看到了一个相反的和统计学上显著的凹（形）相关性，在60天时达到低谷，在晚期CRC的间隔和诊断之间（P<0.001）。这项研究提供的证据表明，较长的诊断间隔与更先进的CRC。此外，该研究无法定义具体的“安全”等待时间，因为初级保健间隔的长度似乎从第一天起就有负面影响。
The benefits from expedited diagnosis of symptomatic cancer are uncertain. We aimed to analyse the relationship between stage of colorectal cancer (CRC) and the primary and specialist care components of the diagnostic interval. We identified seven independent data sets from population-based studies in Scotland, England, Canada, Denmark and Spain during 1997–2010 with a total of 11 720 newly diagnosed CRC patients, who had initially presented with symptoms to a primary care physician. Data were extracted from patient records, registries, audits and questionnaires, respectively. Data sets were required to hold information on dates in the diagnostic interval (defined as the time from the first presentation of symptoms in primary care until the date of diagnosis), symptoms at first presentation in primary care, route of referral, gender, age and histologically confirmed stage. We carried out reanalysis of all individual data sets and, using the same method, analysed a pooled individual patient data set. The association between intervals and stage was similar in the individual and combined data set. There was a statistically significant convex (∩-shaped) association between primary care interval and diagnosis of advanced (i.e., distant or regional) rather than localised CRC (P=0.004), with odds beginning to increase from the first day on and peaking at 90 days. For specialist care, we saw an opposite and statistically significant concave (∪-shaped) association, with a trough at 60 days, between the interval and diagnosis of advanced CRC (P<0.001). This study provides evidence that longer diagnostic intervals are associated with more advanced CRC. Furthermore, the study cannot define a specific ‘safe’ waiting time as the length of the primary care interval appears to have negative impact from day one.
登录
查看更多内容
影响因子：
3.9
作者：
Jensen H;Tørring ML;Larsen MB;Vedsted P
通讯作者：
Vedsted P
影响因子：
2
作者：
DURRLEMAN, S;SIMON, R
通讯作者：
SIMON, R
影响因子：
2.8
作者：
Hansen RP;Vedsted P;Sokolowski I;Søndergaard J;Olesen F
通讯作者：
Olesen F
影响因子：
8.8
作者：
Benitez-Majano, S.;Fowler, H.;Rachet, B.
通讯作者：
Rachet, B.
影响因子：
7.2
作者：
Lynch, Brigid M.;Youlden, Danny;Aitken, Joanne F.
通讯作者：
Aitken, Joanne F.