Department of Surgery and Cancer, St Mary's Hospital Campus.
School of Public Health, Imperial College London, Dorset Rise, London, UK.
Dis Esophagus. 2019 Dec 13;32(10):1-11. doi: 10.1093/dote/doy132.
NICE referral guidelines for suspected cancer were introduced to improve prognosis by reducing referral delays. However, over 20% of patients with esophagogastric cancer experience three or more consultations before referral. In this retrospective cohort study, we hypothesize that such a delay is associated with a worse survival compared with patients referred earlier. By utilizing Clinical Practice Research Datalink, a national primary care linked database, the first presentation, referral date, a number of consultations before referral and stage for esophagogastric cancer patients were determined. The risk of a referral after one or two consultations compared with three or more consultations was calculated for age and the presence of symptom fulfilling the NICE criteria. The risk of death according to the number of consultations before referral was determined, while accounting for stage and surgical management. 1307 patients were included. Patients referred after one (HR 0.80 95% CI 0.68-0.93 p = 0.005) or two consultations (HR 0.81 95% CI 0.67-0.98 p = 0.034) demonstrated significantly improved prognosis compared with those referred later. The risk of death was also lower for patients who underwent a resection, were younger or had an earlier stage at diagnosis. Those presenting with a symptom fulfilling the NICE criteria (OR 0.27 95% CI 0.21-0.35 p < 0.0001) were more likely to be referred earlier. This is the first study to demonstrate an association between a delay in referral and worse prognosis in esophagogastric patients. These findings should prompt further research to reduce primary care delays.
NICE 推荐的疑似癌症患者转诊指南旨在通过减少转诊延误来改善预后。然而，超过 20%的食管癌和胃癌患者在转诊前需要进行三次或更多次就诊。在这项回顾性队列研究中，我们假设与更早转诊的患者相比，这种延迟与更差的生存结果相关。通过利用临床实践研究数据链接，这是一个全国性的初级保健相关数据库，确定了食管癌和胃癌患者的首次就诊、转诊日期、转诊前的就诊次数和分期。计算了与转诊前三次或更多次就诊相比，转诊一次或两次就诊的风险，同时考虑了年龄和符合 NICE 标准的症状。根据转诊前的就诊次数确定了死亡风险，同时考虑了分期和手术管理。共纳入 1307 例患者。与转诊较晚的患者相比，转诊后一次（HR 0.80，95%CI 0.68-0.93，p = 0.005）或两次（HR 0.81，95%CI 0.67-0.98，p = 0.034）的患者预后显著改善。接受切除术、年龄较小或诊断时较早的患者的死亡风险也较低。符合 NICE 标准的症状患者（OR 0.27，95%CI 0.21-0.35，p < 0.0001）更有可能更早转诊。这是第一项表明食管癌和胃癌患者转诊延迟与预后较差之间存在关联的研究。这些发现应促使进一步研究以减少初级保健延误。
