Apollos Jeyakumar R, Sami Sharukh, Prasanth Manju Nadh, Jeyakumar Jerusha, McFadyen Angus K
Department of General Surgery, Dumfries and Galloway Royal Infirmary, Dumfries, DG2 8RX, UK.
University of Aberdeen, King's College, Aberdeen, AB24 3FX, UK.
Ann Med Surg (Lond). 2018 Sep 10;34:66-70. doi: 10.1016/j.amsu.2018.07.011. eCollection 2018 Oct.
Pancreatic ductal adenocarcinomas are poor prognostic cancers accounting for 3% of all cancer cases in the UK. They often present late in the course of the disease process with non-specific symptoms, including gastro-intestinal(GI) symptoms. Delays in diagnosis occur when investigations are carried out in a primary care setting for GI symptoms. The aim of this study was to assess delays in pancreatic cancer diagnosis when patients were referred for GI investigations and evaluate its effect on survival.
Retrospective cohort study of all patients diagnosed with pancreatic adenocarcinoma in a Scottish district general hospital over a seven year period from January 2010 to December 2016. Patients were divided into two groups, those who had a GI investigation 18 months prior to the pancreatic cancer diagnosis and those who did not have GI investigations. Data on demographics, symptoms on referral, stage of disease at diagnosis, treatment undergone and length of survival collected and analysed.
One hundred and fifty-three patients were diagnosed with pancreatic cancer in the study period. Forty (26%) of the 153 underwent gastrointestinal investigations in the 18 months prior to diagnosis. The remaining 113 (74%) had no gastro-intestinal investigations in the same time period. Demographic data were comparable. Significant delays occurred from referral to diagnosis in the GI investigated group compared to those who did not have GI investigations. (64.5days vs 9 days, p = 0.001). No difference was noted in disease stage or treatments undergone between the groups. There was no difference in the average survival after diagnosis between the two groups with median of 108 days for those who underwent GI investigations to 97 days for those who did not.(U = 2079.5, p = 0.454).
Delays caused by pre-diagnostic GI investigations do not appear to contribute to the poor prognosis of pancreatic cancer. Recently updated NICE Guidelines recommends early ultrasound or CT in patients with GI symptoms and weight loss which may reduce delays in diagnosis. Screening tests in future may become cost effective and diagnose this condition at a curable stage which in turn may improve survival rates.
胰腺导管腺癌是预后较差的癌症，在英国占所有癌症病例的3%。它们常在疾病进程后期出现非特异性症状，包括胃肠道（GI）症状。当在初级保健机构针对胃肠道症状进行检查时，会出现诊断延迟。本研究的目的是评估患者因胃肠道检查而转诊时胰腺癌诊断的延迟情况，并评估其对生存的影响。
对2010年1月至2016年12月期间在苏格兰一家地区综合医院被诊断为胰腺腺癌的所有患者进行回顾性队列研究。患者分为两组，一组在胰腺癌诊断前18个月进行了胃肠道检查，另一组未进行胃肠道检查。收集并分析了人口统计学数据、转诊时的症状、诊断时的疾病阶段、接受的治疗以及生存时长。
在研究期间，153例患者被诊断为胰腺癌。其中40例（26%）在诊断前18个月接受了胃肠道检查。其余113例（74%）在同一时期未进行胃肠道检查。人口统计学数据具有可比性。与未进行胃肠道检查的患者相比，接受胃肠道检查的组从转诊到诊断出现了显著延迟。（64.5天对9天，p = 0.001）。两组在疾病阶段或接受的治疗方面没有差异。两组诊断后的平均生存期没有差异，接受胃肠道检查的患者中位数为108天，未接受检查的患者为97天。（U = 2079.5，p = 0.454）。
诊断前的胃肠道检查导致的延迟似乎并未导致胰腺癌预后不良。最近更新的英国国家卫生与临床优化研究所（NICE）指南建议，对于有胃肠道症状和体重减轻的患者应尽早进行超声或CT检查，这可能会减少诊断延迟。未来的筛查测试可能会变得具有成本效益，并在可治愈阶段诊断出这种疾病，进而提高生存率。
