Christensen E D, Harvald T, Jendresen M, Aggestrup S, Petterson G
Department of Thoracic and Cardiovascular Surgery, Rigshospitalet, University Hospital Copenhagen, Denmark.
Eur J Cardiothorac Surg. 1997 Dec;12(6):880-4. doi: 10.1016/s1010-7940(97)00275-3.
The purpose of this investigation was to study the correlation between diagnostic delay and the stage of the lung cancer at the time of operation. A second objective was to study differences in symptoms between the patients grouped according to stage.
A total of 172 patients consecutively admitted for surgery between 1 January 1994 and 1 June 1995 at the Department of Thoracic and Cardiovascular Surgery of Rigshospitalet National Hospital of Denmark were included in the retrospective study. Two groups of patients were compared, one group with good prognosis (patients in Stages I and II) and one group with poor prognosis (patients in Stages III and IV). The time-spans studied were: (1) interval from the patient's perception of the first symptom to operation; and (2) the time from first contact with the healthcare-system to operation. The median delay between the patient-groups was compared using the Mann-Whitney U-test. To compare the symptoms which brought the patients in contact with the healthcare-system, the chi2-test was used.
In the time interval between appearance of the first symptom and operation, a significantly shorter median delay was found for patients with Stages I and II compared to Stages III and IV (P = 0.037). Concerning the interval from first contact with the healthcare system to operation a significantly shorter median delay was found for the group of patients in Stage I and II compared to the patients-group in Stage III and IV (P = 0.017). It was found that the cancer was an accidental finding, significantly more often in patients in Stages I or II compared to patients in Stages III or IV (P = 0.0002).
A few months delay before final treatment of a non-small-cell lung cancer seems to have an impact on the perioperative stage of the cancer, and thereby on the patients prognosis. A screening of asymptomatic risk-group patients will result in recognition of early lung cancer.
本研究旨在探讨诊断延迟与手术时肺癌分期之间的相关性。另一个目的是研究根据分期分组的患者之间症状的差异。
1994年1月1日至1995年6月1日期间，丹麦国立医院里格霍斯帕勒特胸心血管外科连续收治的172例接受手术的患者纳入本回顾性研究。比较两组患者，一组预后良好（Ⅰ期和Ⅱ期患者），一组预后不良（Ⅲ期和Ⅳ期患者）。研究的时间跨度为：（1）从患者感知到首个症状至手术的间隔时间；（2）从首次接触医疗系统至手术的时间。使用曼-惠特尼U检验比较两组患者之间的中位延迟时间。为比较使患者接触医疗系统的症状，使用卡方检验。
在首个症状出现至手术的时间间隔内，Ⅰ期和Ⅱ期患者的中位延迟时间明显短于Ⅲ期和Ⅳ期患者（P = 0.037）。关于从首次接触医疗系统至手术的间隔时间，Ⅰ期和Ⅱ期患者组的中位延迟时间明显短于Ⅲ期和Ⅳ期患者组（P = 0.017）。发现癌症为偶然发现的情况，Ⅰ期或Ⅱ期患者明显多于Ⅲ期或Ⅳ期患者（P = 0.0002）。
非小细胞肺癌最终治疗前延迟数月似乎会影响癌症的围手术期分期，进而影响患者预后。对无症状风险组患者进行筛查将有助于发现早期肺癌。
