Bradley Stephen H, Neal Richard D, Callister Matthew Ej, Cornwell Benjamin, Hamilton William T, Abel Gary A, Shinkins Bethany, Hubbard Richard B, Barclay Matthew E
School of Medicine and Population Health, University of Sheffield, Sheffield.
Department of Health and Community Sciences, University of Exeter, Exeter.
Br J Gen Pract. 2025 May 2;75(754):e323-e332. doi: 10.3399/BJGP.2024.0466. Print 2025 May.
Evidence is equivocal on whether general practice rates of investigation in symptomatic patients using chest X-ray (CXR) affect outcomes.
To determine whether there is an association between rates of CXR requested in general practice and lung cancer outcomes.
Observational study using data on English general practices.
Cancer registry data for patients diagnosed with lung cancer in 2014-2018 were linked to data on general practice CXRs from 2013 until 2017. Cancer stage at diagnosis (I/II versus III/IV) and 1-year and 5-year survival rates (conditional on survival to 1 year) post-diagnosis were reported by general practice quintile of CXR rate, with adjustment for population differences (age, smoking, prevalence of chronic obstructive pulmonary disease and heart failure, ethnicity, and deprivation) and by unadjusted category (low, medium, and high).
In total, 192 631 patient records and CXR rates for 7409 practices were obtained. Practices in the highest quintile of CXR rate had fewer cancers diagnosed at stage III/IV compared with those in the lowest quintile (odds ratio [OR] 0.87, 95% confidence interval [CI] = 0.83 to 0.92, <0.001). The association was weaker for the high unadjusted CXR category (OR 0.94, 95% CI = 0.91 to 0.97). For the highest adjusted quintile, hazard ratios (HRs) for death within 1 year and 5 years were 0.92 (95% CI = 0.90 to 0.95, <0.001) and 0.95 (95% CI = 0.91 to 0.99, = 0.023), respectively. For the high unadjusted CXR category, the HR for 1-year survival was 0.98 (95% CI = 0.96 to 0.99, = 0.004), with no association demonstrated for 5-year survival.
Patients registered at general practices with higher CXR use have a favourable stage distribution and slightly better survival. This supports the use of CXR in promoting earlier diagnosis of symptomatic lung cancer in general practice.
对于全科医疗中对有症状患者进行胸部X光（CXR）检查的比例是否会影响治疗结果，证据并不明确。
确定全科医疗中CXR检查申请比例与肺癌治疗结果之间是否存在关联。
使用来自英国全科医疗的数据进行观察性研究。
将2014 - 2018年诊断为肺癌的患者的癌症登记数据与2013年至2017年的全科医疗CXR数据相链接。根据CXR检查比例的全科医疗五分位数报告诊断时的癌症分期（I/II期与III/IV期）以及诊断后1年和5年生存率（以存活至1年为条件），并对人群差异（年龄、吸烟、慢性阻塞性肺疾病和心力衰竭患病率、种族和贫困程度）进行调整，同时按未调整类别（低、中、高）进行分析。
总共获得了192631份患者记录和7409家医疗机构的CXR检查比例。CXR检查比例最高的五分位数组的医疗机构中，III/IV期诊断出的癌症患者比最低五分位数组的少（优势比[OR]为0.87，95%置信区间[CI]=0.83至0.92，P<0.001）。在未调整的高CXR类别中，这种关联较弱（OR为0.94，95%CI = 0.91至0.97）。对于调整后最高的五分位数组，1年内和5年内死亡的风险比（HRs）分别为0.92（95%CI = 0.90至0.95，P<0.001）和0.95（95%CI = 0.91至0.99，P = 0.023）。对于未调整的高CXR类别，1年生存率的HR为0.98（95%CI = 0.96至0.99，P = 0.004），5年生存率未显示出关联。
在CXR使用比例较高的全科医疗中登记的患者具有较好的分期分布和稍好的生存率。这支持在全科医疗中使用CXR来促进有症状肺癌的早期诊断。
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