Department of Surgery, Faculty of Medicine, University of Colombo, University Surgical Unit, The National Hospital of Sri Lanka, Colombo, Sri Lanka.
Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka.
Sci Rep. 2023 Nov 23;13(1):20628. doi: 10.1038/s41598-023-47415-y.
The treatment modality of gastric adenocarcinoma (GCA) depends on the stage of the disease at the clinical presentation. Long delays are probably an unfavorable factor for the patient's prognosis. A prospective longitudinal, study involving 145 consecutive GCA was conducted at the National Hospital of Sri Lanka (NHSL). The overall delay (in weeks) was recorded for each patient and divided into four periods-patient, endoscopy, pathology and treatment. The median and Interquartile Range (IQR) duration of delays were calculated and differences were explored with chi square test and Mann Whitney U test Survival analysis was done with Kaplan Meier technique and Cox regression. The median duration of delays for patient, endoscopy, histology reporting delay, other histology delay (specimen transfer delay and report receipt delay) and treatment were 18 (IQR 14-27), 2 (IQR 2-3), 3 (IQR 2-3), 2 (IQR 1-2) and 6 (IQR 4-8) weeks respectively. Delayed patient presentation to hospital was associated with significant adverse median survival 16 (IQR 11.5-22.5) weeks versus 20 (IQR 16-27.5) weeks, p = 0.004. Delay in initiating treatment was associated with significantly lower median survival 04 (IQR 4-6) weeks versus 06 (IQR 4-8) weeks, p = 0.003. Over 60% of both proximal and distal GCA presented at an advanced radiological stage (stage III/IV). The Kaplan Meier analysis showed that the higher hazard function was associated with a higher tumour stage and undergoing chemotherapy. Age of the patient and the treatment modality were significant predictors of the survival. Patient delay and delay in initiation of definitive treatment are the most important factors that adversely affect the outcomes of GCA. Public health interventions aiming to shorten the patient delay time with proper referral for specialist care would play an important role. Also, it is important to minimize these preventable delays and there should be time limits in producing the histopathology report and to establish online portals of hospital and laboratory information systems for easy access of histology reports in future.
胃腺癌 (GCA) 的治疗方式取决于临床发病时的疾病阶段。较长的延迟可能对患者的预后不利。在斯里兰卡国家医院 (NHSL) 进行了一项涉及 145 例连续 GCA 的前瞻性纵向研究。记录每位患者的总延迟（以周为单位），并分为四个阶段-患者、内镜、病理和治疗。计算中位数和四分位距 (IQR) 延迟时间，并使用卡方检验和曼-惠特尼 U 检验探索差异。使用 Kaplan-Meier 技术和 Cox 回归进行生存分析。患者、内镜、组织学报告延迟、其他组织学延迟（标本转移延迟和报告接收延迟）和治疗的中位延迟时间分别为 18（IQR 14-27）、2（IQR 2-3）、3（IQR 2-3）、2（IQR 1-2）和 6（IQR 4-8）周。患者延迟到医院就诊与显著不良中位生存相关 16（IQR 11.5-22.5）周与 20（IQR 16-27.5）周，p=0.004。开始治疗的延迟与显著较低的中位生存相关 04（IQR 4-6）周与 06（IQR 4-8）周，p=0.003。近端和远端 GCA 的 60%以上在放射学晚期（III/IV 期）呈现。Kaplan-Meier 分析表明，较高的危险函数与较高的肿瘤分期和接受化疗有关。患者年龄和治疗方式是生存的显著预测因素。患者延迟和确定治疗开始的延迟是对 GCA 结果产生不利影响的最重要因素。旨在通过适当转介给专科医生来缩短患者延迟时间的公共卫生干预措施将发挥重要作用。此外，重要的是要尽量减少这些可预防的延迟，并应在制作组织病理学报告时设定时间限制，并建立医院和实验室信息系统的在线门户，以便将来方便获取组织学报告。
