Teppo Heikki, Koivunen Petri, Hyrynkangas Kalevi, Alho Olli-Pekka
Department of Otorhinolaryngology, University of Oulu, BOX 5000, FIN-90014, Finland.
Head Neck. 2003 May;25(5):389-94. doi: 10.1002/hed.10208.
Clinical stage at the time of diagnosis is the most important determinant of prognosis in cancers of the head and neck. Accordingly, delay in diagnosis could worsen survival in laryngeal cancer, although this hypothesis has not been verified in previous studies.
To determine the effects of patient and professional diagnostic delays on survival in patients with laryngeal squamous cell carcinoma (LSCC), a population-based sample of 66 patients with LSCC in Northern Finland between 1990 and 1995 was investigated. In addition to clinical data from tertiary care units and mortality data from the national death register, we collected data about the first medical visit in primary care that resulted, subsequently, in the diagnosis of malignancy.
Long professional delay in diagnosis (>or=12 months) was an independent and statistically significant determinant of worsened prognosis (adjusted relative hazard of death 4.74, p =.05). There was no correlation between patient delay and prognosis. Another significant factor related to impaired prognosis was advanced stage (IV vs I-III, adjusted relative hazard of death 5.18, p =.02). Long professional delay was not significantly related to any of the demographic or clinical characteristics.
A long professional delay is a marked and independent determinant of impaired survival in laryngeal carcinoma and equals the effect of advanced stage. However, unlike in most other cancers, early symptoms and slow tumor growth give the physician a fairly long time to reach the correct diagnosis before the delay turns out to be fatal.
诊断时的临床分期是头颈癌预后的最重要决定因素。因此，诊断延迟可能会使喉癌患者的生存率降低，尽管这一假设在以往研究中尚未得到验证。
为了确定患者延迟和专业诊断延迟对喉鳞状细胞癌（LSCC）患者生存率的影响，对1990年至1995年间芬兰北部66例LSCC患者的基于人群的样本进行了调查。除了来自三级医疗机构的临床数据和国家死亡登记处的死亡率数据外，我们还收集了初级保健中首次就诊的数据，这些就诊随后导致了恶性肿瘤的诊断。
专业诊断延迟较长（≥12个月）是预后恶化的一个独立且具有统计学意义的决定因素（调整后的死亡相对风险为4.74，p = 0.05）。患者延迟与预后之间没有相关性。与预后受损相关的另一个重要因素是晚期（IV期与I - III期相比，调整后的死亡相对风险为5.18，p = 0.02）。专业诊断延迟较长与任何人口统计学或临床特征均无显著相关性。
专业诊断延迟较长是喉癌生存率受损的一个显著且独立的决定因素，其影响等同于晚期。然而，与大多数其他癌症不同的是，早期症状和肿瘤生长缓慢使医生在延迟变得致命之前有相当长的时间做出正确诊断。
