Gregor A, Thomson C S, Brewster D H, Stroner P L, Davidson J, Fergusson R J, Milroy R
Lothian University Hospitals NHS Trust, Edinburgh EH4 2XU, UK.
Thorax. 2001 Mar;56(3):212-7. doi: 10.1136/thorax.56.3.212.
The prognosis of patients with lung cancer in Scotland is poor and not improving. This study was designed to document factors influencing referral, diagnostic evaluation, treatment, and survival in patients with lung cancer.
Patients diagnosed during 1995 were identified from the Scottish Cancer Registry and their medical records were reviewed. Adequate records were available in 91.2% of all potentially eligible cases.
In 1995, patients in Scotland with lung cancer had a high rate of microscopic verification (74.1%) and 75.3% were assessed by a respiratory physician; however, only 56.8% received active treatment (resection 10.7%, radiotherapy 35.8%, chemotherapy 16.1%) and 2.9% participated in a clinical trial. Survival was poor with a median of 3.6 months; 21.1% (95% CI 19.8% to 22.4%) were alive at 1 year and 7.0% (95% CI 6.2% to 7.8%) at 3 years. Management by respiratory physician, oncologist, or thoracic surgeon was an independent predictor of access to potentially curative treatment and better survival.
This national population based study demonstrates low use of treatment, poor survival, and the influence of process of care on survival. Implementation of evidence-based guidelines will require substantial changes in practice. Increasing the number of patients who receive treatment may improve survival.
苏格兰肺癌患者的预后较差且无改善。本研究旨在记录影响肺癌患者转诊、诊断评估、治疗及生存的因素。
从苏格兰癌症登记处识别出1995年诊断的患者，并对其病历进行审查。在所有可能符合条件的病例中，91.2%有完整记录。
1995年，苏格兰肺癌患者的显微镜确诊率较高（74.1%），75.3%由呼吸内科医生进行评估；然而，仅56.8%接受了积极治疗（手术切除10.7%，放疗35.8%，化疗16.1%），2.9%参与了临床试验。生存情况较差，中位生存期为3.6个月；1年生存率为21.1%（95%可信区间19.8%至22.4%），3年生存率为7.0%（95%可信区间6.2%至7.8%）。由呼吸内科医生、肿瘤内科医生或胸外科医生进行管理是获得潜在治愈性治疗及更好生存的独立预测因素。
这项基于全国人群的研究表明治疗利用率低、生存率差以及医疗过程对生存的影响。实施循证指南将需要在实践中进行重大改变。增加接受治疗的患者数量可能会提高生存率。
