Mehta Samir P, Bailey Diana, Davies Nick
Department of Upper Gastrointestinal Surgery, Royal Bournemouth Hospital, Bournemouth, UK.
Ann R Coll Surg Engl. 2010 Sep;92(6):515-8. doi: 10.1308/003588410X12664192075855. Epub 2010 Jun 1.
The incidence of oesophageal and gastric cardia adenocarcinoma has increased rapidly over the previous two decades. There has been a rise in the number of younger patients affected, and the disease may be more aggressive and have a worse prognosis in these individuals. Current UK guidelines for urgent cancer referral focus on patients who are over 55 years. This study prospectively compares the referral times and outcome in a cohort of patients diagnosed with oesophagogastric cancer under the age of 55 years with a matched cohort over 55 of age.
Every patient diagnosed with oesophageal, junctional or gastric cancer under the age of 55 years and every subsequent patient over the age of 55 years was accepted into this study. In all, 17 hospitals participated over a 12-month period. The following data were recorded: duration of symptoms, number of fast-track referrals, duration from GP referral to first hospital visit and stage at presentation. A survival analysis between the two groups was conducted at 2 years after the end of recruitment.
In total, 102 patients under the age of 55 years were diagnosed with oesophagogastric cancer during the study period. There were fewer fast-track referrals from GPs in this group compared to the over 55-year matched cases (29.4% vs 40.2%). Duration of time from GP referral to first hospital visit was significantly longer in the under 55-year group (median 14 days vs 11 days; P = 0.045 Mann-Whitney). Stage at presentation was similar between groups, but a higher proportion of patients under 55 years were offered a curative treatment plan compared to those over 55 years (P < 0.01). Survival analysis conducted at 2 years after the end of recruitment demonstrated a longer median survival in the under 55-year group (348 days vs 248 days; P = 0.03 log rank).
Although there was a longer referral time in patients under the age of 55 years, this had no effect on disease stage at presentation. Patients under the age of 55 years diagnosed with oesophageal or gastric cancer appear to have a better prognosis than those aged over 55 years.
在过去二十年中，食管癌和贲门腺癌的发病率迅速上升。受影响的年轻患者数量有所增加，并且在这些个体中，该疾病可能更具侵袭性且预后更差。英国当前的紧急癌症转诊指南侧重于55岁以上的患者。本研究前瞻性地比较了一组55岁以下被诊断为食管胃癌的患者与一组匹配的55岁以上患者的转诊时间和结局。
每一位55岁以下被诊断为食管癌、交界性癌或胃癌的患者以及每一位随后的55岁以上患者均纳入本研究。在12个月的时间里，共有17家医院参与。记录了以下数据：症状持续时间、快速转诊次数、从全科医生转诊到首次医院就诊的时间以及就诊时的分期。在招募结束后2年对两组进行生存分析。
在研究期间，共有102名55岁以下的患者被诊断为食管胃癌。与55岁以上的匹配病例相比，该组全科医生的快速转诊较少（29.4%对40.2%）。55岁以下组从全科医生转诊到首次医院就诊的时间明显更长（中位数14天对11天；曼-惠特尼检验P = 0.045）。两组就诊时的分期相似，但与55岁以上患者相比，55岁以下患者中接受治愈性治疗方案的比例更高（P < 0.01）。招募结束后2年进行的生存分析显示，55岁以下组的中位生存期更长（348天对248天；对数秩检验P = 0.03）。
尽管55岁以下患者的转诊时间更长，但这对就诊时的疾病分期没有影响。55岁以下被诊断为食管癌或胃癌的患者似乎比55岁以上的患者预后更好。
