Universidad Pompeu Fabra, Barcelona. Spain.
Rev Esp Enferm Dig. 2011 Jan;103(1):13-9. doi: 10.4321/s1130-01082011000100003.
To evaluate the effectiveness of a fast track diagnosis and treatment program for colorectal cancer (CRC) in reducing the diagnosis to treatment interval (DTI) and tumor stage. To analyze the association between DTI and tumor stage.
A quasi-experimental study with a control group was conducted, and 156 incident cases of CRC referred through a preferential pathway between July 2005 and December 2008 in a tertiary hospital were included, after excluding those treated urgently, treated by endoscopic polypectomy only or having periodic colonoscopies. A control group of 156 patients was randomly selected from all the patients referred through habitual pathways, frequency matched by tumor location, age and year of entry. Data was analyzed with multivariate linear and logistic regression.
Mean DTI was 39.20 days (95% CI: 36.21-42.42) for fast track patients and 63.40 days (95% CI: 57.08-70.41) for controls (p < 0.001), and this difference persisted after multivariate analysis. The odds of having a DTI longer than 30 days was 4.79 (95% CI: 2.19-10.51) higher for controls. There were no significant differences in tumor stage according to the pathway followed. Independently of the track followed, a DTI longer than 30 days was associated with advanced tumor stages for colon cancer, while it was associated with low stages for rectal cancer.
The PDTR strategy is effective in reducing DTI and may reduce patients' and relatives' anxiety. However, it is far from reaching the DTI recommended. The achieved reduction of the delay has no impact on tumor stage.
评估快速诊断和治疗结直肠癌（CRC）方案在缩短诊断至治疗时间（DTI）和肿瘤分期方面的效果。分析 DTI 与肿瘤分期之间的关系。
采用准实验性对照研究，纳入 2005 年 7 月至 2008 年 12 月期间通过一家三级医院优先途径就诊的 156 例 CRC 新发病例，排除紧急治疗、仅内镜下息肉切除术治疗或定期结肠镜检查的患者。从所有通过常规途径就诊的患者中随机选择了 156 例对照组患者，按照肿瘤位置、年龄和进入年份进行频数匹配。采用多元线性和逻辑回归进行数据分析。
快速通道患者的平均 DTI 为 39.20 天（95%CI：36.21-42.42），对照组为 63.40 天（95%CI：57.08-70.41）（p<0.001），多变量分析后仍存在差异。对照组 DTI 超过 30 天的可能性比快速通道患者高 4.79 倍（95%CI：2.19-10.51）。肿瘤分期与就诊途径无关。独立于就诊途径，DTI 超过 30 天与结肠癌的晚期肿瘤分期相关，而与直肠癌的低分期相关。
PDTR 策略可有效缩短 DTI，减轻患者和家属的焦虑。然而，远未达到推荐的 DTI。所实现的延迟缩短对肿瘤分期没有影响。
