National Cancer Intelligence Network, 133-155 Wellington House, Waterloo Road, London SE1 8UG, UK.
Br J Cancer. 2013 Oct 15;109(8):2027-34. doi: 10.1038/bjc.2013.569. Epub 2013 Sep 17.
The short-term survival following a cancer diagnosis in England is lower than that in comparable countries, with the difference in excess mortality primarily occurring in the months immediately after diagnosis. We assess the impact of emergency presentation (EP) on the excess mortality in England over the course of the year following diagnosis.
All colorectal and cervical cancers presenting in England and all breast, lung, and prostate cancers in the East of England in 2006-2008 are included. The variation in the likelihood of EP with age, stage, sex, co-morbidity, and income deprivation is modelled. The excess mortality over 0-1, 1-3, 3-6, and 6-12 months after diagnosis and its dependence on these case-mix factors and presentation route is then examined.
More advanced stage and older age are predictive of EP, as to a lesser extent are co-morbidity, higher income deprivation, and female sex. In the first month after diagnosis, we observe case-mix-adjusted excess mortality rate ratios of 7.5 (cervical), 5.9 (colorectal), 11.7 (breast ), 4.0 (lung), and 20.8 (prostate) for EP compared with non-EP.
Individuals who present as an emergency experience high short-term mortality in all cancer types examined compared with non-EPs. This is partly a case-mix effect but EP remains predictive of short-term mortality even when age, stage, and co-morbidity are accounted for.
英国癌症患者的短期生存率低于其他可比国家，这种超额死亡率的差异主要发生在诊断后最初几个月。我们评估了紧急就诊（EP）对诊断后一年内英国超额死亡率的影响。
纳入了 2006-2008 年在英国就诊的所有结直肠癌和宫颈癌，以及东英格兰地区的所有乳腺癌、肺癌和前列腺癌。对年龄、分期、性别、合并症和收入贫困与 EP 发生可能性的变化进行建模。然后检查诊断后 0-1、1-3、3-6 和 6-12 个月的超额死亡率及其对这些病例组合因素和就诊途径的依赖性。
更晚期和年龄较大的患者更有可能出现 EP，合并症、收入贫困程度较高和女性的预测作用较小。在诊断后的第一个月，我们观察到 EP 与非 EP 相比，调整病例组合后的超额死亡率比分别为 7.5（宫颈癌）、5.9（结直肠癌）、11.7（乳腺癌）、4.0（肺癌）和 20.8（前列腺癌）。
与非 EP 相比，所有研究癌症类型的 EP 患者在短期死亡率都较高。这部分是病例组合的影响，但即使考虑到年龄、分期和合并症，EP 仍然是短期死亡率的预测因素。
