Chinese Preventive Medicine Association, Beijing, People's Republic of China.
Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.
JCO Glob Oncol. 2024 Sep;10:e2400209. doi: 10.1200/GO.24.00209.
Survival from esophageal cancer (EC) is poor, partly reflecting the delay in diagnosis. To inform the potential measures for downstaging the disease, we estimated diagnosis delay, that is, the length of interval from symptom-to-diagnosis (STD), and investigated its correlates among patients with EC in a high-risk resource-limited rural area in China.
Patients newly diagnosed with EC (N = 411) were recruited in a secondary hospital in Henan province in China between August 1, 2018, and October 21, 2020. A face-to-face structured questionnaire was used to collect patient-level and health-seeking data from patients and/or proxies. Association between the length of STD interval and stage at diagnosis was examined using logistic regression. Correlates of the length of the STD interval were identified using negative binomial regression.
The median STD interval was 61 (IQR, 24-155) days, with the time from symptom onset to first health care contact representing 90.1% (IQR, 7.8%-100%) of its length. The odds of being diagnosed at stages III-IV increased by 3% (age- and sex-adjusted odds ratio, 1.03 [95% CI, 0.99 to 1.08]) for every 2-month increase in the STD interval. Higher awareness of EC risk factors was associated with shorter STD intervals (incidence rate ratio [95% CI] for awareness score ≥2 ≤0: 0.65 [0.46 to 0.93]), whereas patients who first visited secondary or tertiary/cancer hospitals had much longer STD intervals than those who first visited a primary health care facility (1.69 [1.19 to 2.40]; 2.22 [1.24 to 3.97]).
The median length of the STD interval was 2 months, but with considerable interindividual variability. Improving EC awareness, coupled with effective referral pathways, may promote timely diagnosis of this disease.
食管癌（EC）的生存率较差，部分原因是诊断延迟。为了了解潜在的疾病降级措施，我们估计了诊断延迟，即从症状到诊断（STD）的时间间隔，并在中国一个资源有限的农村高危地区的 EC 患者中调查了其相关性。
2018 年 8 月 1 日至 2020 年 10 月 21 日，我们在中国河南省的一家二级医院招募了 411 名新诊断为 EC 的患者。我们使用面对面的结构化问卷从患者及其代理人收集患者层面和求医数据。使用逻辑回归检查 STD 间隔长度与诊断时分期的关系。使用负二项回归确定 STD 间隔长度的相关因素。
STD 间隔的中位数为 61（IQR，24-155）天，从症状出现到首次医疗接触的时间占其长度的 90.1%（IQR，7.8%-100%）。STD 间隔每增加 2 个月，诊断为 III-IV 期的几率增加 3%（年龄和性别调整后的优势比，1.03 [95%CI，0.99 至 1.08]）。对 EC 危险因素的认识越高，STD 间隔越短（知晓评分≥2 的发生率比[95%CI]为 0.65 [0.46 至 0.93]），而首次就诊于二级或三级/癌症医院的患者的 STD 间隔比首次就诊于初级保健机构的患者长得多（1.69 [1.19 至 2.40]；2.22 [1.24 至 3.97]）。
STD 间隔的中位数为 2 个月，但个体间差异很大。提高 EC 意识，加上有效的转诊途径，可能有助于及时诊断该病。
