Department Surgery and Cancer, Imperial College London, London, UK.
St Mark's Hospital and Academic Institute, Harrow, UK.
Ann Surg. 2018 Apr;267(4):711-715. doi: 10.1097/SLA.0000000000002224.
To identify patient factors that are associated with emergency presentation of esophageal and gastric cancer, and further to evaluate long-term prognosis in this cohort.
The incidence of emergency presentation is variable, with the prognosis of patients stabilized and discharged to return for elective surgery unknown.
The primary admission of patients with esophageal or gastric cancer within the Hospital Episode Statistics database (1997-2012) was used to classify as emergency or elective diagnosis. Multivariate regression analyses were used to identify patient factors associated with emergency diagnosis and prognosis.
A total of 35,807 (29.4%) and 45,866 (39.6%) patients with esophageal and gastric cancer presented as an emergency over the study period. Age ≥70, female sex, non-white ethnicity, Charlson comorbidity index score ≥3 and more deprived Townsend index were independent predictors of emergency cancer diagnosis. Emergency diagnosis was an independent predictor of increased 5-year mortality for all patients with esophageal cancer [hazard ratio (HR) = 1.63, 95% confidence interval (CI) 1.61-1.65] and gastric cancer (HR = 1.20, 95% CI 1.16-1.23). Specifically patients receiving surgery on an elective follow-up admission with an initial emergency diagnosis had a poorer prognosis (esophageal cancer: HR = 1.35, 95% CI 1.27-1.44, gastric cancer: HR = 1.13. 95% CI 1.04-1.22), with a significant increase in liver recurrence (esophageal cancer: 7.1% vs 4.9%; P < 0.001, gastric cancer: 7.0% vs 4.8%; P < 0.001) compared to patients referred electively.
Emergency presentation of esophageal and gastric cancer is associated with a poor prognosis, due to the increased incidence of metastatic disease at diagnosis and a higher recurrence rate after surgery.
确定与食管和胃癌急诊就诊相关的患者因素，并进一步评估该队列的长期预后。
急诊就诊的发生率各不相同，且稳定的患者预后以及出院后返回进行择期手术的情况尚不清楚。
使用医院入院统计数据库（1997-2012 年）中食管癌或胃癌患者的初次入院资料，将诊断分为急诊或择期。采用多变量回归分析确定与急诊诊断和预后相关的患者因素。
在研究期间，共有 35807（29.4%）例和 45866（39.6%）例食管癌和胃癌患者急诊就诊。年龄≥70 岁、女性、非白色人种、Charlson 合并症指数评分≥3 分和更贫困的城镇指数是癌症急诊诊断的独立预测因素。对于所有食管癌患者，急诊诊断是 5 年死亡率增加的独立预测因素[风险比（HR）=1.63，95%置信区间（CI）1.61-1.65]和胃癌（HR=1.20，95%CI 1.16-1.23）。具体而言，初始急诊诊断后接受择期随访入院手术的患者预后较差（食管癌：HR=1.35，95%CI 1.27-1.44，胃癌：HR=1.13，95%CI 1.04-1.22），肝复发率显著增加（食管癌：7.1%比 4.9%；P<0.001，胃癌：7.0%比 4.8%；P<0.001）与择期转介的患者相比。
食管癌和胃癌的急诊就诊与预后不良相关，这是由于诊断时转移性疾病的发生率增加以及手术后复发率较高所致。
