Department of Oncology, University of Alberta, Cross Cancer Institute, T6G 1Z2, Edmonton, AB, Canada.
Int J Colorectal Dis. 2023 May 31;38(1):148. doi: 10.1007/s00384-023-04443-4.
To evaluate the patterns of emergency department visits before diagnosis with digestive neuroendocrine neoplasms (NENs).
Linked administrative databases from the province of Alberta, Canada, were examined, and patients diagnosed with digestive NENs from 2004 to 2019 were reviewed. Incidents of emergency department visits in the 3 months before histological diagnosis were reviewed. Multivariable logistic regression analyses were used to examine factors associated with at least one emergency department (ED) visit as well as factors associated with more than one ED visit. The impact of pre-diagnosis ED visits on overall survival was further assessed in a multivariable Cox regression model, which included (in addition to ED visits), age at diagnosis, sex, histology, Charlson comorbidity index, and stage.
A total of 2120 patients were considered eligible for the study, and they were included in the analysis (including 1041 patients (49.1%) with at least one ED visit in the 3 months before diagnosis). The following factors were associated with a higher likelihood of an ED visit prior to diagnosis: younger age (OR with increasing age: 0.983; 95% CI: 0.977-0.989), higher comorbidity index (OR: 1.332; 95% CI: 1.215-1.460), female sex (OR: 1.292; 95% CI: 1.084-1.540), and stage IV (OR: 1.515; 95% CI: 1.106-2.075). Likewise, the following factors were associated with more than one ED visit within 3 months before diagnosis: younger age (OR with increasing age: 0.985; 95% CI: 0.979-0.992), higher comorbidity index (OR: 1.280; 95% CI: 1.167-1.405), and female sex (OR: 1.516; 95% CI: 1.230-1.868). Using multivariable Cox regression modeling, the following factors were associated with worse overall survival (higher risk of death): older age (HR: 1.050; 95% CI: 1.043-1.056), higher comorbidity index (HR: 1.280; 95% CI: 1.209-1.356), stage IV (HR: 3.163; 95% CI: 2.562-3.905), neuroendocrine carcinoma histology (HR: 1.645; 95% CI: 1.350-2.003), pre-diagnosis ED visit (HR: 1.784; 95% CI: 1.529-2.083).
Almost one-half of patients with NENs visit the ED within 3 months before diagnosis. ED visits were associated with younger age, female sex, advanced disease, and higher comorbidity. Moreover, pre-diagnosis ED visit(s) were associated with worse overall survival in the current cohort.
评估在诊断为消化道神经内分泌肿瘤（NENs）之前急诊就诊的模式。
分析了来自加拿大艾伯塔省的关联行政数据库，并对 2004 年至 2019 年期间诊断为消化道 NENs 的患者进行了回顾。审查了组织学诊断前 3 个月内急诊就诊的情况。采用多变量逻辑回归分析来研究与至少一次急诊就诊相关的因素，以及与多次急诊就诊相关的因素。进一步在多变量 Cox 回归模型中评估了诊断前急诊就诊对总生存的影响，该模型包括（除急诊就诊外）年龄、性别、组织学、Charlson 合并症指数和分期。
共有 2120 名患者符合研究条件，并纳入分析（包括 1041 名（49.1%）在诊断前 3 个月内至少有一次急诊就诊的患者）。以下因素与诊断前急诊就诊的可能性更高相关：年龄较小（随着年龄增加的 OR：0.983；95%CI：0.977-0.989）、合并症指数较高（OR：1.332；95%CI：1.215-1.460）、女性（OR：1.292；95%CI：1.084-1.540）和 IV 期（OR：1.515；95%CI：1.106-2.075）。同样，以下因素与诊断前 3 个月内多次急诊就诊相关：年龄较小（随着年龄增加的 OR：0.985；95%CI：0.979-0.992）、合并症指数较高（OR：1.280；95%CI：1.167-1.405）和女性（OR：1.516；95%CI：1.230-1.868）。使用多变量 Cox 回归模型，以下因素与总体生存较差（死亡风险较高）相关：年龄较大（HR：1.050；95%CI：1.043-1.056）、合并症指数较高（HR：1.280；95%CI：1.209-1.356）、IV 期（HR：3.163；95%CI：2.562-3.905）、神经内分泌癌组织学（HR：1.645；95%CI：1.350-2.003）和诊断前急诊就诊（HR：1.784；95%CI：1.529-2.083）。
近一半的 NENs 患者在诊断前 3 个月内会到急诊就诊。急诊就诊与年龄较小、女性、晚期疾病和较高的合并症指数相关。此外，在当前队列中，诊断前急诊就诊与总体生存较差相关。
