Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Md.
Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Md; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md.
Am J Med. 2014 May;127(5):443-9. doi: 10.1016/j.amjmed.2013.12.023. Epub 2014 Jan 28.
"Rush to surgery" among patients with worse symptoms, delays related to morbidity, and inclusion of patients with advanced disease in study populations have produced a mixed picture of importance of time to treatment to survival of non-small cell lung cancer. Our objective was to assess the contribution of diagnosis to first surgery interval to survival among patients diagnosed in the community with early-stage non-small cell lung cancer.
Patients with early-stage lung cancer (N = 174) at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins who were diagnosed and treated from 2003 to 2009 and followed through 2011 made up a prospective study of overall survival. Diagnosis to first surgery interval was examined overall, as 2 segments (referral interval and treatment interval), as short and longer intervals, and as a continuous variable.
The majority of patients were female (55%) and aged more than 65 years (61%). The average mean referral and treatment delays were 61.2 and 5.9 days, respectively. Cox method hazard analysis revealed that older age (years) at diagnosis (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.00-1.05), stage IIB (HR, 2.17; 95% CI, 1.12-4.21), large (>4 cm) (HR, 3.68; 95% CI, 1.05-12.93) or unknown tumor size (HR, 4.45; 95% CI, 1.21-16.38), and weeks from diagnosis to first surgery interval (HR, 1.04; 95% CI, 1.00-1.09) predicted worse overall survival. The threshold period of less than 42 days from diagnosis to surgery did not reach statistical significance.
Patients seem to benefit from rapid reduction of tumor burden with surgery. Reasons for delay were not available. Nevertheless, referral delay experienced in the community is unduly long. In addition to patient choices, an unconscious patient or physician bias that lung cancer is untreatable or an inevitable consequence of smoking may be operating and needs further investigation.
在症状较重的患者中“匆忙手术”、与发病相关的延迟以及将晚期疾病患者纳入研究人群，这些因素导致了治疗时间对非小细胞肺癌患者生存的重要性呈现出复杂的情况。我们的目的是评估在社区诊断为早期非小细胞肺癌的患者中，诊断对首次手术间隔时间到生存的贡献。
2003 年至 2009 年在约翰霍普金斯 Sidney Kimmel 综合癌症中心诊断和治疗并随访至 2011 年的早期肺癌（N=174）患者构成了总体生存的前瞻性研究。总体上检查了从诊断到首次手术的间隔时间，将其分为 2 个阶段（转诊间隔和治疗间隔）、短间隔和长间隔以及连续变量。
大多数患者为女性（55%），年龄超过 65 岁（61%）。平均平均转诊和治疗延迟分别为 61.2 天和 5.9 天。Cox 方法风险分析显示，诊断时年龄较大（岁）（风险比[HR]，1.02；95%置信区间[CI]，1.00-1.05）、IIB 期（HR，2.17；95%CI，1.12-4.21）、肿瘤较大（>4cm）（HR，3.68；95%CI，1.05-12.93）或肿瘤大小未知（HR，4.45；95%CI，1.21-16.38），以及从诊断到首次手术的周数（HR，1.04；95%CI，1.00-1.09）预测总体生存较差。从诊断到手术的时间少于 42 天的阈值期没有达到统计学意义。
患者似乎受益于手术快速降低肿瘤负荷。延迟的原因尚不清楚。然而，社区中经历的转诊延迟时间过长。除了患者的选择之外，无意识的患者或医生偏见，即肺癌是无法治疗的或吸烟的必然后果，可能正在起作用，需要进一步调查。
