Maiga Amelia W, Deppen Stephen A, Pinkerman Rhonda, Callaway-Lane Carol, Massion Pierre P, Dittus Robert S, Lambright Eric S, Nesbitt Jonathan C, Baker David, Grogan Eric L
Tennessee Valley Healthcare System, Nashville, Tennessee; Vanderbilt University Medical Center, Nashville, Tennessee.
Tennessee Valley Healthcare System, Nashville, Tennessee.
Ann Thorac Surg. 2017 Dec;104(6):1791-1797. doi: 10.1016/j.athoracsur.2017.06.051. Epub 2017 Oct 21.
Timely care of lung cancer is presumed critical, yet clear evidence of stage progression with delays in care is lacking. We investigated the reasons for delays in treatment and the impact these delays have on tumor-stage progression.
We queried our retrospective database of 265 veterans who underwent cancer resection from 2005 to 2015. We extracted time intervals between nodule identification, diagnosis, and surgical resection; changes in nodule radiographic size over time; final pathologic staging; and reasons for delays in care. Pearson's correlation and Fisher's exact test were used to compare cancer growth and stage by time to treatment.
Median time from referral to surgical evaluation was 11 days (interquartile range, 8 to 17). Median time from identification to therapeutic resection was 98 days (interquartile range, 66 to 139), and from diagnosis to resection, 53 days (interquartile range, 35 to 77). Sixty-eight patients (26%) were diagnosed at resection; the remainder had preoperative tissue diagnoses. No significant correlation existed between tumor growth and time between nodule identification and resection, or between tumor growth and time between diagnosis and resection. Among 197 patients with preoperative diagnoses, 42% (83) had intervals longer than 60 days between diagnosis and resection. Most common reasons for delay were cardiac clearance, staging, and smoking cessation. Larger nodules had fewer days between identification and resection (p = 0.03).
Evaluation, staging, and smoking cessation drive resection delays. The lack of association between tumor growth and time to treatment suggests other clinical or biological factors, not time alone, underlie growth risk. Until these factors are identified, delays to diagnosis and treatment should be minimized.
肺癌的及时治疗被认为至关重要，但缺乏关于治疗延迟导致分期进展的确切证据。我们调查了治疗延迟的原因以及这些延迟对肿瘤分期进展的影响。
我们查询了2005年至2015年间接受癌症切除术的265名退伍军人的回顾性数据库。我们提取了结节识别、诊断和手术切除之间的时间间隔；结节影像学大小随时间的变化；最终病理分期；以及治疗延迟的原因。使用Pearson相关性分析和Fisher精确检验来比较癌症生长和分期与治疗时间的关系。
从转诊到手术评估的中位时间为11天（四分位间距，8至17天）。从识别到治疗性切除的中位时间为98天（四分位间距，66至139天），从诊断到切除的中位时间为53天（四分位间距，35至77天）。68名患者（26%）在切除时被诊断；其余患者有术前组织诊断。肿瘤生长与结节识别和切除之间的时间，或肿瘤生长与诊断和切除之间的时间均无显著相关性。在197名有术前诊断的患者中，42%（83名）在诊断和切除之间间隔超过60天。延迟的最常见原因是心脏评估、分期和戒烟。较大的结节在识别和切除之间的天数较少（p = 0.03）。
评估、分期和戒烟导致切除延迟。肿瘤生长与治疗时间之间缺乏关联表明，生长风险的潜在因素是其他临床或生物学因素，而非时间本身。在确定这些因素之前，应尽量减少诊断和治疗的延迟。
