Luo Qingwei, Yu Xue Qin, Smith David Paul, Goldsbury David Eamon, Cooke-Yarborough Claire, Patel Manish Indravadan, O'Connell Dianne Lesley
Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia.
Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
BMJ Open. 2017 Jan 11;7(1):e014259. doi: 10.1136/bmjopen-2016-014259.
To identify reasons for prostate cancer stage being recorded as 'unknown' in Australia's largest population-based cancer registry.
Prospective population-based cohort.
New South Wales (NSW) is the most populous state in Australia, with almost one third of the total national population.
NSW Cancer Registry (NSWCR) records for prostate cancer cases diagnosed in 2001-2009 were linked to the NSW Admitted Patient Data Collection (APDC) for 2000-2010. All patients in this study had a minimum of 12 months follow-up in the hospital episode records after their date of diagnosis as recorded by the NSWCR.
Incidence of 'unknown' stage prostate cancer and cancer-specific survival.
Of 50 597 prostate cancer cases, 39.9% were recorded as having 'unknown' stage. Up to 4 months after diagnosis, 77.2% of cases without a hospital-reported cancer diagnosis were recorded as having 'unknown' stage. Among those patients with a hospital-reported cancer diagnosis, stage was 'unknown' for 7.6% of cases who received a radical prostatectomy (RP) and for 34.0% of cases who had procedures other than RP. In the latter group, the factors that were related to having 'unknown' stage were living in disadvantaged areas (adjusted OR (aOR) range: 1.13 to 1.20), attending a private hospital (aOR range: 1.25 to 2.13), having day-only admission for care (aOR=1.23, 95% CI 1.11 to 1.36), or having procedures other than multiple procedures with imaging (eg, biopsy only, aOR range: 1.11 to 1.45).
Over half of 'unknown' stage prostate cancer cases did not have a hospital-reported prostate cancer diagnosis within the 4 months after initial diagnosis. We identified differences in the likelihood of cases being recorded as 'unknown' stage based on socioeconomic status and facility type, which suggests that further investigation of reporting practices in relation to diagnostic and treatment pathways is required.
在澳大利亚最大的基于人群的癌症登记处中，确定前列腺癌分期被记录为“未知”的原因。
前瞻性人群队列研究。
新南威尔士州（NSW）是澳大利亚人口最多的州，占全国总人口的近三分之一。
新南威尔士州癌症登记处（NSWCR）记录的2001 - 2009年诊断的前列腺癌病例与2000 - 2010年新南威尔士州住院患者数据收集（APDC）相关联。本研究中的所有患者在新南威尔士州癌症登记处记录的诊断日期后，在医院病历记录中至少有12个月的随访。
“未知”分期前列腺癌的发病率和癌症特异性生存率。
在50597例前列腺癌病例中，39.9%被记录为“未知”分期。诊断后长达4个月，77.2%未在医院报告癌症诊断的病例被记录为“未知”分期。在那些有医院报告癌症诊断的患者中，接受根治性前列腺切除术（RP）的病例中有7.6%分期为“未知”，接受RP以外手术的病例中有34.0%分期为“未知”。在后者组中，与“未知”分期相关的因素包括生活在贫困地区（调整后比值比（aOR）范围：1.13至1.20）、就诊于私立医院（aOR范围：1.25至2.13）、仅日间入院接受治疗（aOR = 1.23，95%可信区间1.11至1.36）或接受除多次影像学检查相关手术以外的手术（例如仅活检，aOR范围：1.11至1.45）。
超过一半的“未知”分期前列腺癌病例在初次诊断后的4个月内未在医院报告前列腺癌诊断。我们发现基于社会经济地位和医疗机构类型，病例被记录为“未知”分期的可能性存在差异，这表明需要进一步调查与诊断和治疗途径相关的报告做法。
