Allison P, Franco E, Black M, Feine J
Faculty of Dentistry, McGill University, Montreal, Canada.
Oral Oncol. 1998 Mar;34(2):147-53. doi: 10.1016/s1368-8375(97)00088-2.
Despite the belief that cancer mortality can be reduced if lesions are detected, diagnosed and treated at an early stage, only one study, among a number concerning cancers of the upper aerodigestive tract (UADT), has found any relationship between such delays and prognosis for this population of cancer patients. The aim of this study was, therefore, to investigate the relationship between patient and professional diagnostic delays and patient prognosis in a group of UADT cancer patients. Patients diagnosed with squamous cell carcinoma of oral cavity sites (ICD-9 141, 143-5)oro-, naso- and hypopharynx (ICD-9 146-8) and larynx (ICD-9 161) were included in the study. Stepwise multiple logistic regression was used to calculate the odds ratio (OR) of late versus early stage disease for selected study variables. The sample comprised 188 subjects. Multivariate analysis found that having a pharyngeal cancer (OR 9.26; 95% CI 4.02-21.32; P: 0.0001) a professional delay > 1 month (OR 2.28; 95% CI 1.13-4.64; P: 0.022) and age > or = 65 years (OR: 0.45; 95% CI: 0.22-0.91; P: 0.024) were predictive of late stage disease. A dose-response relationship between professional delay and OR for late stage disease for the whole sample (P for trend 0.03) and among those with oral cancer (P for trend 0.0001) was found. The results of this study suggest that, among patients with an UADT cancer, professional delays > 1 month are contributing to an increased risk for being diagnosed with late stage disease.
尽管人们认为，如果在早期发现、诊断和治疗病变，癌症死亡率是可以降低的，但在上呼吸道和消化道（UADT）癌症的多项研究中，只有一项研究发现这种延迟与该癌症患者群体的预后之间存在任何关系。因此，本研究的目的是调查一组UADT癌症患者中患者和专业诊断延迟与患者预后之间的关系。被诊断为口腔部位（国际疾病分类第九版141、143 - 5）、口咽、鼻咽和下咽（国际疾病分类第九版146 - 8）以及喉（国际疾病分类第九版161）鳞状细胞癌的患者被纳入研究。采用逐步多元逻辑回归计算选定研究变量的晚期与早期疾病的比值比（OR）。样本包括188名受试者。多变量分析发现，患有咽癌（OR 9.26；95%置信区间4.02 - 21.32；P：0.0001）、专业延迟>1个月（OR 2.28；95%置信区间1.13 - 4.64；P：0.022）以及年龄≥65岁（OR：0.45；95%置信区间：0.22 - 0.91；P：0.024）可预测晚期疾病。在整个样本中（趋势P值0.03）以及口腔癌患者中（趋势P值0.0001），发现专业延迟与晚期疾病的OR之间存在剂量反应关系。本研究结果表明，在UADT癌症患者中，专业延迟>1个月会增加被诊断为晚期疾病的风险。
