[诊断模式对结直肠癌早期诊断的影响]

Jiang Xuan, Yuan Yi-ping, Xu Ding-ting, Zhang Bao, Liu Yu-lan

Division of Gastroenterology and Hepatology, Peking University People's Hospital, Beijing, China.

Zhonghua Yi Xue Za Zhi. 2011 Nov 8;91(41):2886-90.

OBJECTIVE

To explore the influences of diagnostic modes of colorectal cancer (CRC) on an early diagnosis of CRC.

METHODS

A total of 405 cases were randomly collected from 1798 CRC patients registered at our hospital from January 2000 to December 2010. A retrospective chart review was undertaken for all identified cases. Besides the demographics and tumor features, TNM stage was obtained from medical records and pathological forms. Other collected data were as follows: (1) Type of clinical examinations leading to diagnosis. (2) Diagnostic duration: including patient duration (period from initial symptoms to consulting a doctor and hospitalization duration (period from patient first seeing a doctor to a confirmed CRC case). (3) Diagnostic delay and its rate: diagnostic delay was identified as the diagnostic duration of over 30 days. We compared the different delay periods of 31 - 60, 61 - 90, 91 - 150 and > 150 days and its corresponding tumor stages at diagnosis. (4) Misdiagnosis and its rate: that CRC subjects were diagnosed and treated as other diseases for at least 30 days was identified as misdiagnosis. The t and Mann-Whitney U tests were performed for the quantitative data and χ(2) test for the qualitative data.

RESULTS

Among the study subjects, 67.2% (270/402) CRC cases were examined by colonoscopy, 17.4 % (70/402) cases by CT scan or B ultrasound. The median diagnostic duration of CRC was 90 days (25% percentile: 40 days, 75% percentile: 210 days). The median patient duration was 30 days and median hospital duration 10 days. The overall misdiagnostic rate of CRC was 27.9% (112/401), higher (39.7%, 48/121) in right sited CRC than in left sited CRC (22.9%, 63/275) (χ(2) = 11.7, P = 0.00). 77.7% (313/403) cases had > 30 days diagnostic delay, 50.8% (156/307) delay attributable to the patients, while 29.0% (89/307) attributable to hospitals and 20.2% (62/307) attributable to both. The diagnostic duration of early-stage CRC and advanced-stage CRC appeared to be in the same length. On the other hand, no difference of TNM stage at the initial diagnosis was found in groups with different diagnostic durations of 31 - 60, 61 - 90, 91 - 150 and > 150 days (all P > 0.05).

CONCLUSION

Colonoscopy is the most effective in the diagnosis of CRC. The median diagnostic time of CRC is 90 days. The phenomenon of its diagnostic delay often occurs. However, the delay is not a major cause for its advanced stage and a poor outcome. Its inherent biological characteristics may be more important.

目的

探讨结直肠癌（CRC）诊断模式对CRC早期诊断的影响。

方法

从2000年1月至2010年12月在我院登记的1798例CRC患者中随机抽取405例。对所有确诊病例进行回顾性病历审查。除人口统计学和肿瘤特征外，TNM分期从病历和病理表格中获取。其他收集的数据如下：（1）导致诊断的临床检查类型。（2）诊断持续时间：包括患者病程（从初始症状到咨询医生的时间段）和住院病程（从患者首次就诊到确诊CRC病例的时间段）。（3）诊断延迟及其发生率：诊断延迟定义为诊断持续时间超过30天。我们比较了31 - 60天、61 - 90天、91 - 150天和> 150天的不同延迟期及其诊断时相应的肿瘤分期。（4）误诊及其发生率：将CRC患者被诊断并当作其他疾病治疗至少30天定义为误诊。对定量数据进行t检验和Mann-Whitney U检验，对定性数据进行χ²检验。

结果

在研究对象中，67.2%（270/402）的CRC病例通过结肠镜检查，17.4%（70/402）的病例通过CT扫描或B超检查。CRC的中位诊断持续时间为90天（第25百分位数：40天，第75百分位数：210天）。中位患者病程为30天，中位住院病程为10天。CRC的总体误诊率为27.9%（112/401），右侧CRC的误诊率（39.7%，48/121）高于左侧CRC（22.9%，63/275）（χ² = 11.7，P = 0.00）。77.7%（313/403）的病例诊断延迟> 30天，50.8%（156/307）的延迟归因于患者，而29.0%（89/307）归因于医院，20.2%（62/307）归因于两者。早期CRC和晚期CRC的诊断持续时间似乎相同。另一方面，在31 - 60天、61 - 90天、91 - 150天和> 150天的不同诊断持续时间组中，初始诊断时的TNM分期没有差异（所有P > ）。