a Surgical Oncology Unit , Veneto Institute of Oncology IOV IRCCS , Padova , Italy.
b Clinica Chirurgica 3, Dipartimento di Scienze Chirurgiche Oncologiche e Gastroenterologiche DiSCOG , Azienda Ospedaliera-Università di Padova , Padova , Italy.
Acta Oncol. 2018 Sep;57(9):1179-1184. doi: 10.1080/0284186X.2018.1457224. Epub 2018 Mar 30.
The association between shorter time to diagnosis and favorable outcome is still unproven in esophageal cancer. This study aims to evaluate the effect of time to diagnosis on patient prognosis.
Retrospective cohort study of all 3613 symptomatic patients referred for esophageal cancer to our center from 1980 to 2011. Time to diagnosis was calculated as the number of days from first symptom onset to the diagnosis of esophageal cancer. The main outcome measures were: resectability and severe malnutrition at diagnosis; postoperative morbidity, mortality and survival.
Longer time to diagnosis was significantly associated with severe malnutrition at diagnosis (odds ratio (OR): 1.003, 95% confidence interval (C.I.).: 1.001-1.006) but not with resectability (OR: 0.997, 95% C.I.: 0.994-1.001). Longer time to diagnosis was not associated with postoperative morbidity (OR: 1.000, 95% C.I.: 0.998-1.003), postoperative mortality (OR: 1.002, 95% C.I.: 0.998-1.006), five-year overall survival (hazard ratio (HR): 0.999, 95% C.I.: 0.997-1.001) or five-year disease free survival (HR: 0.999, 95% C.I.: 0.998-1.001).
Longer time to diagnosis did not affect resectability, postoperative morbidity or survival. Further campaigns to raise awareness of cancer among population and primary health care providers may have limited effect on clinical outcome.
在食管癌中，较短的诊断时间与较好的预后之间的关联尚未得到证实。本研究旨在评估诊断时间对患者预后的影响。
回顾性队列研究，纳入了 1980 年至 2011 年期间因食管癌就诊于我们中心的所有 3613 例有症状患者。诊断时间的计算方法为从首次症状出现到确诊食管癌的天数。主要结局指标为：诊断时的可切除性和严重营养不良；术后发病率、死亡率和生存率。
较长的诊断时间与诊断时的严重营养不良显著相关（优势比（OR）：1.003，95%置信区间（CI）：1.001-1.006），但与可切除性无关（OR：0.997，95%CI：0.994-1.001）。诊断时间延长与术后发病率（OR：1.000，95%CI：0.998-1.003）、术后死亡率（OR：1.002，95%CI：0.998-1.006）、五年总生存率（风险比（HR）：0.999，95%CI：0.997-1.001）或五年无病生存率（HR：0.999，95%CI：0.998-1.001）无关。
诊断时间延长并不影响可切除性、术后发病率或生存率。提高公众和初级保健提供者对癌症的认识的进一步宣传活动可能对临床结果的影响有限。
