Deshwar Amar B, Sugar Elizabeth, Torto Deirdre, De Jesus-Acosta Ana, Weiss Matthew J, Wolfgang Christopher L, Le Dung, He Jin, Burkhart Richard, Zheng Lei, Laheru Daniel, Yarchoan Mark
School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
School of Public Health, Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA.
Ann Pancreat Cancer. 2018;1. doi: 10.21037/apc.2018.02.01. Epub 2018 Feb 27.
Pancreatic ductal adenocarcinoma (PDAC) often presents with nonspecific symptoms and the workup is not standardized. To study the impact of delays in diagnosis and in the initiation of treatment, we investigated the relationship between length of diagnostic intervals and surgical resectability.
We performed a retrospective chart review of patients evaluated for PDAC at Johns Hopkins in 2014. Data were collected on the patient (date of first symptoms-first medical appointment), diagnostic (first medical appointment-diagnosis of PDAC), and treatment (diagnosis of PDAC-1st day of treatment) time intervals, and the upfront treatment received. Asymptomatic patients diagnosed incidentally, or for whom records were incomplete, were excluded from analysis.
Of 453 charts reviewed, 116 patients met inclusion criteria. The median patient interval was 14 days [interquartile range (IQR): 6-30 days], the median diagnostic interval was 22 days (IQR: 8-46 days), and the median treatment interval was 26 days (IQR: 15-35 days). Thirty-eight patients (33%) received upfront surgery and 78 (67%) received nonsurgical treatment. After adjusting for multiple factors, the odds of receiving surgery significantly increased for individuals with a patient interval of 30 days or less [adjusted odds ratio (aOR): 3.41; 95% confidence interval (CI): 1.08-13.20; P=0.050] and with a diagnostic interval of 60 days or less (aOR: 15.68; 95% CI: 2.95-291.00, P=0.009).
A patient interval less than 1 month and a diagnostic interval less than 2 months for symptomatic PDAC are associated with increased odds of upfront surgical resection. These data provide initial evidence that reducing diagnostic delays may lead to improved outcomes in PDAC.
胰腺导管腺癌（PDAC）通常表现为非特异性症状，且检查方法不规范。为研究诊断延迟和治疗开始延迟的影响，我们调查了诊断间隔时长与手术可切除性之间的关系。
我们对2014年在约翰霍普金斯医院接受PDAC评估的患者进行了回顾性病历审查。收集了患者（首次症状出现日期 - 首次就医日期）、诊断（首次就医 - PDAC诊断）和治疗（PDAC诊断 - 治疗首日）时间间隔的数据，以及接受的初始治疗情况。偶然诊断出的无症状患者或记录不完整的患者被排除在分析之外。
在审查的453份病历中，116名患者符合纳入标准。患者间隔的中位数为14天[四分位间距（IQR）：6 - 30天]，诊断间隔的中位数为22天（IQR：8 - 46天），治疗间隔的中位数为26天（IQR：15 - 35天）。38名患者（33%）接受了初始手术，78名患者（67%）接受了非手术治疗。在对多个因素进行调整后，患者间隔为30天或更短的个体接受手术的几率显著增加[调整后的优势比（aOR）：3.41；95%置信区间（CI）：1.08 - 13.20；P = 0.050]，诊断间隔为60天或更短的个体接受手术的几率也显著增加（aOR：15.68；95% CI：2.95 - 291.00，P = 0.009）。
有症状的PDAC患者间隔小于1个月且诊断间隔小于2个月与初始手术切除几率增加相关。这些数据提供了初步证据，表明减少诊断延迟可能会改善PDAC的治疗结果。
