Keith D J, Jones T, Ives A, de Berker D, Verne J
University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Public Health England-South West, Bristol, UK.
Clin Exp Dermatol. 2017 Mar;42(2):145-152. doi: 10.1111/ced.12989. Epub 2017 Jan 2.
The incidence of skin cancer is increasing. The two-week wait conversion rate (TWWCR) is the percentage of urgent suspected skin cancer referrals that are confirmed as cancer.
To examine the relationships between different epidemiological factors and TWWCR for malignant melanoma (MM) and cutaneous squamous cell carcinoma (SCC).
We extracted data from the National Cancer Data Repository (NCDR) and National Cancer Waiting Times Monitoring Dataset between 2009 and 2010 for MM and SCC in England. We conducted partial correlation and stepwise multiple regression analysis on TWWCR, age, incidence, detection rate, tumour thickness (MM only), percentage MM/SCC and social deprivation. We also looked at the two-week wait referral rate (TWWRR) and incidence rate with respect to age.
TWWCR was significantly correlated with age when partial correlation was used to control for the factors described above for MM (P < 0.05) and SCC (P < 0.001). Stepwise regression of these factors returned only age as significant in the final model for MM (P < 0.001) and SCC (P < 0.01). Incidence of MM and SCC increased with age. TWWRR also increase with age, but with higher rate in younger people relative to their incidence.
Age is a predictor of TWWCR independent of the other factors measured, including thickness and incidence. This may be explained by the higher number of referrals for younger patients despite the lower incidence of skin cancer in this group. This may reflect a more appropriate rate of referral in order to achieve earlier diagnosis and better outcomes.
皮肤癌的发病率正在上升。两周等待确诊率（TWWCR）是紧急疑似皮肤癌转诊病例中被确诊为癌症的比例。
研究不同流行病学因素与恶性黑色素瘤（MM）和皮肤鳞状细胞癌（SCC）的两周等待确诊率之间的关系。
我们从2009年至2010年的国家癌症数据储存库（NCDR）和国家癌症等待时间监测数据集中提取了英格兰MM和SCC的数据。我们对两周等待确诊率、年龄、发病率、检出率、肿瘤厚度（仅MM）、MM/SCC百分比和社会剥夺程度进行了偏相关和逐步多元回归分析。我们还研究了两周等待转诊率（TWWRR）和年龄别发病率。
在对上述因素进行控制后，采用偏相关分析时，MM（P < 0.05）和SCC（P < 0.001）的两周等待确诊率与年龄显著相关。对这些因素进行逐步回归分析后，在MM（P < 0.001）和SCC（P < 0.01）的最终模型中，只有年龄具有显著性。MM和SCC的发病率随年龄增长而增加。两周等待转诊率也随年龄增长而增加，但年轻人的转诊率相对于其发病率更高。
年龄是两周等待确诊率的一个预测因素，独立于所测量的其他因素，包括肿瘤厚度和发病率。这可能是因为尽管该年龄组皮肤癌发病率较低，但年轻患者的转诊数量较多。这可能反映了为实现早期诊断和更好的治疗效果而采用的更合适的转诊率。
