Gilde Jason, Song Brian, Masroor Farzad, Darbinian Jeanne A, Ritterman Weintraub Miranda L, Salazar James, Yang Eleanor, Gurushanthaiah Deepak, Wang Kevin H
Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California, U.S.A.
Laryngoscope. 2018 Aug;128(8):1867-1873. doi: 10.1002/lary.27038. Epub 2017 Dec 15.
To examine the current diagnostic pathway of oropharyngeal squamous cell carcinoma (OPSCC) and identify factors associated with time to diagnosis.
Retrospective cohort study of patients with OPSCC in an integrated healthcare system from January 1, 2013, to December 31, 2013. Patient demographics, tobacco and alcohol use, chief complaint, tumor stage, human papilloma virus (HPV) status, physician factors (diagnosis, antibiotic prescription, performance of endoscopic exam, biopsy), and time intervals were examined. Time variations by patient characteristics and physician practice were assessed.
We identified 152 patients with OPSCC. Of those, 90% had stage III to IV disease. The cohort was largely male (85%), white (79%), with HPV-positive tumors (84%). Most common chief complaints were neck mass (52%) and sore throat (20%). Among those with neck a mass, 94% had HPV-positive tumors. Prescription of antibiotics was associated with longer time to first otolaryngology evaluation. Median time from symptom onset to first primary care physician (PCP) contact was 3.0 weeks; from PCP to otolaryngologist was 1.1 weeks, and from otolaryngologist to tissue diagnosis was 0.4 weeks. At the first otolaryngology visit, 82% underwent in-office flexible endoscopy and 58% had same-day biopsy, resulting in rapid time to tissue diagnosis. Diagnostic time intervals did not differ by HPV status.
The overall diagnostic process was efficient, although initial antibiotic treatment resulted in longer time to first otolaryngology visit. Tumor HPV status was associated with presenting findings but not time to diagnosis. The variation in diagnostic delay time and impact on survival outcomes is unknown and merits further investigation.
研究口咽鳞状细胞癌（OPSCC）当前的诊断途径，并确定与诊断时间相关的因素。
对2013年1月1日至2013年12月31日在一个综合医疗系统中患有OPSCC的患者进行回顾性队列研究。检查了患者的人口统计学特征、烟草和酒精使用情况、主要症状、肿瘤分期、人乳头瘤病毒（HPV）状态、医生因素（诊断、抗生素处方、内镜检查的实施、活检）以及时间间隔。评估了患者特征和医生实践导致的时间差异。
我们确定了152例OPSCC患者。其中，90%患有III至IV期疾病。该队列主要为男性（85%）、白人（79%），肿瘤HPV阳性（84%）。最常见的主要症状是颈部肿块（52%）和喉咙痛（20%）。在有颈部肿块的患者中，94%的肿瘤HPV阳性。抗生素处方与首次耳鼻喉科评估的时间延长有关。从症状出现到首次与初级保健医生（PCP）接触的中位时间为3.0周；从PCP到耳鼻喉科医生为1.1周，从耳鼻喉科医生到组织诊断为0.4周。在首次耳鼻喉科就诊时，82%的患者接受了门诊柔性内镜检查，58%的患者进行了当日活检，从而实现了较快的组织诊断时间。诊断时间间隔在HPV状态方面没有差异。
尽管最初的抗生素治疗导致首次耳鼻喉科就诊时间延长，但总体诊断过程是高效的。肿瘤HPV状态与呈现的症状有关，但与诊断时间无关。诊断延迟时间的差异及其对生存结果的影响尚不清楚，值得进一步研究。
4。《喉镜》，2018年，第1867 - 1873页。
