结直肠癌患者转诊来源与结局的关系。

The association between referral source and outcome in patients with colorectal cancer.

机构信息

Colorectal Unit, Bristol Royal Infirmary, King Edward VII Building, Upper Maudlin Street, Bristol BS2 8HW, UK.

出版信息

Surgeon. 2013 Jun;11(3):141-6. doi: 10.1016/j.surge.2012.10.004. Epub 2012 Dec 11.

DOI:10.1016/j.surge.2012.10.004

PMID:23238513

Abstract

AIM

The colorectal two-week wait fast track (FT) referral system was nationally implemented in the UK in 2000 to ensure patients with colorectal cancer (CRC) received prompt access to specialized services. The aim of this study was to determine the association between the mechanism of referral to colorectal services and the 5-year outcomes for patients with CRC.

METHODS

Consecutive patients with newly diagnosed CRC presenting between October 2002 and September 2004 were identified retrospectively. Analysis for survival and recurrence of disease at 5 years from presentation was undertaken. Outcomes for patients were compared between fast track (FT), non-fast track (NFT) and emergency referral (ER) routes, using Kaplan-Meier survival estimates.

RESULTS

Out of 189 patients, 96 (51%) presented via the FT, 41 (22.5%) via the NFT and 52 (27.5%) via the ER referral route. The 5-year overall survival was 52.6% ± 5.1, 41.5% ± 7.7 and 38.5% ± 6.7 for the FT-, NFT- and ER groups respectively (p = 0.075). The 5-year cancer specific survival was 60.3% ± 5.2, 58.8% ± 5.3 and 43.5% ± 7.2 for the FT-, NFT- and ER groups respectively (p = 0.056). Patients referred as emergencies had worse 5-year overall survival; 49.3% ± 4.3 (FT&NFT) vs. 38.5% ± 6.7 (ER) (p = 0.042) and 5-year cancer specific survival 59.8% ± 4.4 (FT&NFT) vs. 43.5% ± 7.2 (ER) (p = 0.016). A total of 136 patients (FT n = 71, NFT n = 34, ER n = 31) underwent potentially curative surgery. Differences in 5-year survival did not reach statistical significance in these patients.

CONCLUSION

Referral route to specialist services for patients with CRC via the fast track pathway compared to non-fast track pathway was not associated with improved survival.

摘要

目的

英国于 2000 年在全国范围内实施了结直肠癌两周快速通道（FT）转诊系统，以确保结直肠癌患者能够及时获得专业服务。本研究旨在确定向结直肠服务机构转诊的机制与结直肠癌患者 5 年预后之间的关系。

方法

回顾性分析 2002 年 10 月至 2004 年 9 月期间新诊断为结直肠癌的连续患者。从就诊时起，对 5 年的生存和疾病复发情况进行分析。采用 Kaplan-Meier 生存估计，比较快速通道（FT）、非快速通道（NFT）和紧急转诊（ER）途径患者的预后。

结果

在 189 名患者中，96 名（51%）通过 FT 途径就诊，41 名（22.5%）通过 NFT 途径就诊，52 名（27.5%）通过 ER 途径就诊。FT-、NFT-和 ER 组的 5 年总生存率分别为 52.6%±5.1%、41.5%±7.7%和 38.5%±6.7%（p=0.075）。FT-、NFT-和 ER 组的 5 年癌症特异性生存率分别为 60.3%±5.2%、58.8%±5.3%和 43.5%±7.2%（p=0.056）。急诊就诊的患者 5 年总生存率较差；49.3%±4.3%（FT&NFT）vs.38.5%±6.7%（ER）（p=0.042）和 5 年癌症特异性生存率 59.8%±4.4%（FT&NFT）vs.43.5%±7.2%（ER）（p=0.016）。共有 136 名患者（FT n=71，NFT n=34，ER n=31）接受了潜在可治愈的手术。在这些患者中，5 年生存率的差异没有达到统计学意义。