Evans Sue M, Murphy Declan G, Davis Ian D, Sengupta Shomik, Borzeshi Ehsan Zare, Sampurno Fanny, Millar Jeremy L
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Division of Cancer Surgery, University of Melbourne, Peter MacCallum Cancer Centre, Prahran, Victoria, Australia.
Asia Pac J Clin Oncol. 2018 Oct;14(5):e412-e419. doi: 10.1111/ajco.12875. Epub 2018 Apr 27.
This study aims to assess characteristics of patients with prostate cancer for whom clinical T stage category (cT) was not documented in the medical record and assess whether specialists had concordant conclusions regarding cT based on digital rectal examination (DRE) notes.
Data from the Prostate Cancer Outcome Registry - Victoria (PCOR-Vic) were interrogated. Four specialists independently assigned cT to DRE notes. Words, or part thereof, associated with agreement between clinicians were identified.
Of the 10 587 men, cT was documented in 8758 (82.7%) cases. Multivariate analysis indicated that poor cT documentation was associated with older patient age (odds ratio [OR] 0.80, 95% confidence interval [CI] 0.66-0.99 if 75.1-85 years; OR 0.50, 95%CI 0.36-0.72 if >85 years); diagnosis via transperineal compared to transrectal ultrasound-guided biopsy (TRUS) (OR 0.68, 95%CI 0.51-0.91); diagnosed in a private hospital (OR 0.85, 95%CI 0.75-0.96); and a diagnostic Gleason score of >8 compared to ≤6 (OR 0.59, 95%CI = 0.48-0.73). cT was more likely documented in men diagnosed via transurethral resection of prostate (OR 2.06, 95%CI 1.64-2.58) compared to TRUS and/or if receiving treatment in a radiotherapy center (OR 3.44, 95%CI 2.80-4.23 for external beam radiotherapy; OR 3.57 95%CI 2.44-5.23 for brachytherapy and OR 1.34, 95%CI 1.06-1.69 for combination surgery and radiotherapy) compared to those undergoing radical prostatectomy. Agreement in cT assignment ranged from kappa of 0.158 to 0.582. Stem word components in DRE notes associated with poorest level of agreement were "abnorm," "hard," "nodul" and those with highest level of agreement were terms "benign" and "smooth."
Mode of diagnosis/subsequent treatment, and cancer characteristics were associated with cT documentation. Third party interpretation of clinical notes is problematic.
本研究旨在评估病历中未记录临床T分期类别（cT）的前列腺癌患者的特征，并评估专家基于直肠指检（DRE）记录对cT是否有一致的结论。
对前列腺癌结局登记处 - 维多利亚（PCOR-Vic）的数据进行查询。四位专家独立为DRE记录分配cT分期。确定了与临床医生之间的一致性相关的单词或其部分内容。
在10587名男性中，8758例（82.7%）记录了cT分期。多变量分析表明，cT记录不佳与患者年龄较大有关（优势比[OR]为0.80，95%置信区间[CI]为0.66 - 0.99，年龄在75.1 - 85岁之间；OR为0.50，95%CI为0.36 - 0.72，年龄>85岁）；与经直肠超声引导下活检（TRUS）相比，经会阴诊断（OR为0.68，95%CI为0.51 - 0.91）；在私立医院诊断（OR为0.85，95%CI为0.75 - 0.96）；诊断性Gleason评分为>8 compared to ≤6（OR为0.59，95%CI = 0.48 - 0.73）。与TRUS相比，经尿道前列腺切除术诊断的男性更有可能记录cT分期（OR为2.06，95%CI为1.64 - 2.58），和/或与接受根治性前列腺切除术的男性相比，如果在放疗中心接受治疗（外照射放疗的OR为3.44，95%CI为2.80 - 4.23；近距离放疗的OR为3.57，95%CI为2.44 - 5.23；手术和放疗联合的OR为1.34，95%CI为1.06 - 1.69）。cT分期分配的一致性范围为kappa值0.158至0.582。DRE记录中与一致性最差水平相关的词干成分是“异常”“硬”“结节”，与一致性最高水平相关的词是“良性”和“光滑”。
诊断/后续治疗方式以及癌症特征与cT记录有关。临床记录的第三方解读存在问题。
