Pencavel Tim D, Strauss Dirk C, Thomas Greg P, Thomas J Meirion, Hayes Andrew J
Sarcoma and Melanoma Unit, Department of Academic Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK.
Ann R Coll Surg Engl. 2010 Jul;92(5):417-21. doi: 10.1308/003588410X12664192075972. Epub 2010 May 19.
The NHS Cancer Plan was introduced in 2000 and included guidelines for the rapid assessment and referral of cases of suspected malignancy. We wished to assess the efficiency and appropriateness of patients referred under the Department of Health's general practitioner referral guidelines implemented for sarcomas in December 2000.
A retrospective case-note review was performed of all patients referred to our regional soft tissue sarcoma unit between 1 January 2004 and 31 December 2008. Patients referred under the two-week guidelines and all patients referred routinely were analysed. The main outcome measures were the total number of patients referred on the basis of the two-week guidelines and the proportion they constitute of all referrals. The referring criteria were noted and compared to the observed criteria recorded. The final histological diagnosis of patients referred on the basis of the two-week guidelines are documented.
A total of 2746 referrals for suspected sarcoma were made from January 2004 to December 2008. Of these, 154 referrals were made under the two-week rule of which 102 were referred purely on the clinical criteria for suspected soft tissue sarcoma. The remaining patients were referred after non-urgent special investigations indicated the possibility of sarcoma. Twelve patients referred under the two-week rule were proved to have sarcoma, nine after specific investigations including imaging or histological diagnosis. Of the 102 patients referred on clinical suspicion of a sarcoma, two patients had proven soft tissue sarcomas and one patient a cutaneous sarcoma. Between 2004 and 2008, the number of 2-week referrals rose 25-fold but accounted for an increase of less than 1% of the sarcomas treated in this unit.
The numbers of all referrals for suspected sarcoma are increasing; however, the rate of increase of 2-week referrals is increasing faster than routine referrals and will exceed it in 2012 if current trends continue. There has not been a commensurate rise in the detection of sarcoma or, more specifically, diagnosis of the deep sarcomas associated with worse prognosis. Current clinical guidelines have essentially had no impact on the early diagnosis and treatment of soft tissue sarcoma, and may negatively impact on the treatment of patients with proven sarcoma by delaying treatment within a regional centre because of redirection of a large number of patients with benign abnormalities to such centres.
《国民健康服务体系癌症计划》于2000年推出，其中包括疑似恶性肿瘤病例快速评估和转诊的指南。我们希望评估根据2000年12月实施的卫生部针对肉瘤的全科医生转诊指南转诊的患者的效率和适宜性。
对2004年1月1日至2008年12月31日期间转诊至我们地区软组织肉瘤科室的所有患者进行回顾性病例记录审查。分析了根据两周指南转诊的患者以及所有常规转诊的患者。主要观察指标是根据两周指南转诊的患者总数及其占所有转诊患者的比例。记录转诊标准并与记录的观察标准进行比较。记录了根据两周指南转诊患者的最终组织学诊断。
2004年1月至2008年12月期间，共收到2746例疑似肉瘤的转诊。其中，154例是根据两周规则转诊的，其中102例纯粹是根据疑似软组织肉瘤的临床标准转诊的。其余患者是在非紧急特殊检查提示有肉瘤可能后转诊的。根据两周规则转诊的12例患者被证实患有肉瘤，其中9例是在进行包括影像学或组织学诊断在内的特定检查后确诊的。在102例因临床怀疑肉瘤而转诊的患者中，2例被证实患有软组织肉瘤，1例患有皮肤肉瘤。2004年至2008年期间，两周内转诊的病例数增加了25倍，但在本单位接受治疗的肉瘤患者中所占比例增加不到1%。
疑似肉瘤的所有转诊病例数在增加；然而，两周内转诊病例数的增加速度比常规转诊病例数快，如果目前的趋势持续下去，到2012年将超过常规转诊病例数。肉瘤的检出率并没有相应上升，或者更具体地说，与预后较差相关的深部肉瘤的诊断率没有相应上升。目前的临床指南对软组织肉瘤的早期诊断和治疗基本上没有影响，而且可能会因为大量良性异常患者被转诊到区域中心而导致在区域中心内延误治疗，从而对确诊为肉瘤的患者的治疗产生负面影响。
