Department of Otorhinolaryngology, Kanta-Häme Central Hospital, Hämeenlinna, Finland.
Oral Oncol. 2009 Aug;45(8):692-5. doi: 10.1016/j.oraloncology.2008.10.012. Epub 2008 Dec 17.
Comorbidity and diagnostic delay are independent prognostic factors in head and neck cancer, most notably in laryngeal cancer. We investigated their inter-relationship and their relative significance in survival of three different head and neck cancers. A population-based retrospective cohort of 221 patients with cancer of oral tongue, pharynx or larynx diagnosed between 1986 and 1996. Diagnostic delays and data on the onset of symptoms from real-time primary care charts. Comorbidity classified according to Charlson comorbidity index. Survival analyses were performed using Cox multivariate model. Significant association was found between increased comorbidity score and long professional delay in laryngeal cancer. In tongue cancer, longer patient delay and increased comorbidity were associated. In laryngeal cancer, high comorbidity (adjusted hazard ratio HR 5.6), professional delay of 6 months (HR 3.3) and advanced stage (HR 3.8) all were independent determinants of survival. In laryngeal cancer, comorbid illnesses are associated with professional diagnostic delay. However, despite their inter-correlation both comorbidity and professional delay are significant and independent prognostic factors.
合并症和诊断延迟是头颈部癌症的独立预后因素，在喉癌中尤为明显。我们研究了它们在三种不同头颈部癌症中的相互关系及其对生存的相对重要性。在 1986 年至 1996 年间诊断为口腔舌、咽或喉癌的 221 例基于人群的回顾性队列研究。从实时初级保健图表中获取诊断延迟和症状发作的数据。根据 Charlson 合并症指数对合并症进行分类。使用 Cox 多变量模型进行生存分析。在喉癌中发现合并症评分增加与专业延迟时间长之间存在显著相关性。在舌癌中，较长的患者延迟和增加的合并症与相关。在喉癌中，高合并症（调整后的危险比 HR5.6）、6 个月的专业延迟（HR3.3）和晚期（HR3.8）都是生存的独立决定因素。在喉癌中，合并症与专业诊断延迟有关。然而，尽管它们相互关联，但合并症和专业延迟都是重要且独立的预后因素。
