Maguire A, Porta M, Malats N, Gallén M, Piñol J L, Fernandez E
Department of Epidemiology, Universitat Autònoma de Barcelona, Spain.
Eur J Cancer. 1994;30A(6):785-92. doi: 10.1016/0959-8049(94)90293-3.
The time interval between onset of symptoms and the diagnosis of cancer [symptom to diagnosis interval (SDI), or duration of symptoms] is a highly complex variable reflecting patient behaviour, the clinical course, the functioning of the health system and tumour biology. In order to assess possible forms of the risk function of SDI upon cancer survival whilst taking into account the effects of age, sex, tumour site and stage at diagnosis, 1887 symptomatic cases of lung, breast, stomach, colon, rectal, bladder cancer and lymphomas registered in the Tumour Registry of the Hospital del Mar (Barcelona) were analysed by means of survival curves and Cox proportional hazards regression. Subjects (mean age 64 years) were followed for a median length of 15 months after diagnosis (follow-up rate 93.5%). SDI showed a weak relationship with tumour stage at diagnosis and with survival: out of the seven sites studied, only in breast cancer was tumour extension at diagnosis significantly influenced by duration of symptoms, and only lung and rectal cancers showed a detectable form of the risk function of SDI upon survival; neither was linear, and for rectal cancer the relationship was complexly related with tumour stage. Hence, results show that forms of the risk function of duration of symptoms on cancer survival are specific to tumour sites, and that the interval should not be represented as a linear, continuous term. Studies analysing more complex sets of factors, processes and forms of the SDI function are needed.
从症状出现到癌症确诊之间的时间间隔[症状至诊断间隔（SDI），即症状持续时间]是一个高度复杂的变量，反映了患者行为、临床病程、卫生系统功能以及肿瘤生物学特性。为了在考虑年龄、性别、肿瘤部位及确诊时的分期等因素影响的情况下，评估SDI的风险函数对癌症生存的可能形式，我们通过生存曲线和Cox比例风险回归分析了巴塞罗那海洋医院肿瘤登记处登记的1887例有症状的肺癌、乳腺癌、胃癌、结肠癌、直肠癌、膀胱癌及淋巴瘤病例。研究对象（平均年龄64岁）在确诊后中位随访15个月（随访率93.5%）。SDI与确诊时的肿瘤分期及生存率之间关系较弱：在所研究的七个部位中，仅乳腺癌确诊时的肿瘤范围受症状持续时间的显著影响，且仅肺癌和直肠癌显示出SDI对生存的可检测风险函数形式；两者均非线性，且直肠癌的这种关系与肿瘤分期复杂相关。因此，结果表明症状持续时间对癌症生存的风险函数形式因肿瘤部位而异，且该间隔不应表示为线性的连续项。需要开展分析更复杂的SDI函数因素、过程及形式组合的研究。
