Lung cancer: clinical presentation and specialist referral time
Lung cancer: clinical presentation and specialist referral time
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DOI：
10.1183/09031936.04.00113603
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发表时间：
2004-12-01
影响因子：
24.3
通讯作者：
Ferrigno, D
中科院分区：
文献类型：
--
作者：
Buccheri, G;Ferrigno, D
许多教科书描述了肺癌的症状和体征，但提及的是旧系列患者。为了更新有关肺癌表现的知识，对 1,277 名连续肺癌患者进行了研究，这些患者从 1989 年 1 月到 2002 年 10 月在同一机构就诊。对所有患者前瞻性记录了一组 33 个人体测量、临床、物理、实验室、放射学、病理学和随访变量。此外，还获得了有关警报症状（即潜在问题）、专家转诊时间以及就诊症状组合的信息。对患者进行了仔细随访，并记录了他们随后的临床病程。在研究期结束时，无症状的偶然发现的情况更加频繁，并且胸痛的患病率变得不那么常见。在出现的症状中没有发现其他随时间变化的变化。当因咳嗽或出现体重减轻、厌食和乏力等全身症状引起就诊时，专科转诊的延迟时间会更长。在研究结束时，转诊延迟时间更长，这可能与患有合并症的老年患者数量增加有关。正如在单变量分析（有利：偶然发现和胸部感染；不利：胸痛、呼吸困难、全身症状和局部或全身传播症状）和多变量分析（有利：胸部感染）中发现的那样，警报和患病症状都是临床结果的强有力预测因素。肺癌的早期表现具有特定的症状模式。了解这种模式可能有助于提高早期诊断率。
Many textbooks describe symptoms and signs of lung cancer but refer to old series of patients.To update knowledge about lung cancer presentation, a study was carried out on 1,277 consecutive lung cancer patients, who were seen in a single Institution from January 1989 to October 2002. A set of 33 anthropometric, clinical, physical, laboratory, radiological, pathological and follow-up variables was prospectively recorded for all patients. In addition, information was obtained concerning symptoms of alarm (i.e. potential concern), times to specialist referral and the mix of symptoms at presentation. Patients were carefully followed-up and their subsequent clinical course was recorded.Casual discovery with absence of symptoms occurred more frequently towards the end of the study period and the prevalence of chest pain became less common. No other time-dependent changes were found in the presenting symptoms. Delay in specialist referral was longer when presentation was provoked by cough or by the occurrence of systemic symptoms, such as weight loss, anorexia and asthenia. Referral delay was longer towards the end of the study, perhaps related to an increase in the number of elderly patients with co-morbidities. Both alarm and prevalence symptoms were strong predictors of the clinical outcome, as found in both univariate analysis (favourable : casual discovery and chest infection; unfavourable: chest pain, dyspnoea, systemic symptoms and symptoms of local or systemic dissemination) and in multivariate analysis (favourable: chest infection).Early presentation of lung cancer is characterised by a specific symptomatic pattern. Knowledge of this pattern may help to improve the rate of early diagnosis.