Porta M, Gallén M, Malats N, Planas J
Department of Epidemiology (IMIM), Universitat Autonoma de Barcelona, Spain.
J Epidemiol Community Health. 1991 Sep;45(3):225-30. doi: 10.1136/jech.45.3.225.
The aim was to assess the relationship between survival, tumour stage, and the interval from first symptom to diagnosis (SDI, or duration of symptoms).
This was a retrospective follow up study of a cohort of patients registered in the tumour registry of the Hospital del Mar (Barcelona).
Hospital based tumour registry, with patients derived mainly from the City of Barcelona.
1247 cases of lung, breast, stomach, colon, or rectal cancer were analysed using survival curves and Cox proportional hazards regression. Subjects (mean age 63.6 years) were followed for a median length of 12.9 months after diagnosis. At the time of diagnosis one fourth of patients had disseminated disease.
Based on clinical records, a physician registered the onset time of the first symptom attributable to cancer (from which the SDI is computed), as well as the tumour stage at diagnosis. Other measurements followed standard tumour registry procedures. Overall, the crude mean SDI was 5.15 months (SD 8.03, median 2.03); only 24.5% of cases had an SDI less than a month. Crude mean SDIs by anatomical site were as follows: lung cancer 3.07 months; breast 7.44; stomach 5.34; colon 5.74; rectum 5.03. Tumour extension did not appear to be significantly influenced by SDI, only breast cancer showing a distinct pattern of increased extension with increasing SDI. As expected, the probability of survival decreased monotonically with increasing stage in all sites. Tumour site was also a significant predictor of survival, which at one year ranged from 93% for breast cancer to 28% for lung cancer. However, a longer SDI tended sometimes to be associated with a better chance of survival, a fact that was most apparent in colon cancer. All Cox proportional hazards models showed a consistent picture: SDI was not a significant predictor of survival (age and sex adjusted hazard ratios ranging from 0.97 to 1.01), neither was sex; age did predict survival, and so did site and stage.
The results provide further evidence of a very weak relationship between SDI and tumour stage at diagnosis (except for breast cancer), and between SDI and survival, thus emphasising some limitations within which early clinical detection operates. They also suggest that in addition to reflecting patient and physician behaviour, as well as the functioning of the health system, SDI may be influenced by the biological behaviour of the tumour.
旨在评估生存率、肿瘤分期以及从首发症状到诊断的时间间隔（症状持续间隔，或症状持续时间）之间的关系。
这是一项对在巴塞罗那海洋医院肿瘤登记处登记的一组患者进行的回顾性随访研究。
基于医院的肿瘤登记处，患者主要来自巴塞罗那市。
使用生存曲线和Cox比例风险回归分析了1247例肺癌、乳腺癌、胃癌、结肠癌或直肠癌病例。受试者（平均年龄63.6岁）在诊断后中位随访时间为12.9个月。在诊断时，四分之一的患者已有播散性疾病。
根据临床记录，一名医生记录了可归因于癌症的首发症状的发作时间（由此计算症状持续间隔）以及诊断时的肿瘤分期。其他测量遵循标准的肿瘤登记程序。总体而言，症状持续间隔的粗均值为5.15个月（标准差8.03，中位数2.03）；只有24.5%的病例症状持续间隔少于一个月。按解剖部位划分的症状持续间隔粗均值如下：肺癌3.07个月；乳腺癌7.44个月；胃癌5.34个月；结肠癌5.74个月；直肠癌5.03个月。肿瘤扩散似乎未受症状持续间隔的显著影响，只有乳腺癌表现出随着症状持续间隔增加扩散增加的明显模式。正如预期的那样，所有部位的生存率概率均随着分期增加而单调下降。肿瘤部位也是生存的重要预测因素，一年生存率从乳腺癌的93%到肺癌的28%不等。然而，较长的症状持续间隔有时往往与更好的生存机会相关，这一事实在结肠癌中最为明显。所有Cox比例风险模型都显示出一致的情况：症状持续间隔不是生存的显著预测因素（年龄和性别调整后的风险比在0.97至1.01之间），性别也不是；年龄确实可预测生存，部位和分期也是如此。
结果进一步证明了症状持续间隔与诊断时的肿瘤分期之间（乳腺癌除外）以及症状持续间隔与生存之间的关系非常微弱，从而强调了早期临床检测所面临的一些局限性。结果还表明，症状持续间隔除了反映患者和医生的行为以及卫生系统的运作情况外，可能还受肿瘤生物学行为的影响。
