Kesson E, Bucknall C E, McAlpine L G, Milroy R, Hole D, Vernon D R, Macbeth F, Gillis C R
Department of Public Health, GGHB, Glasgow, UK.
Br J Cancer. 1998 Nov;78(10):1391-5. doi: 10.1038/bjc.1998.690.
Current practice and outcome for patients with lung cancer were determined by retrospective case note review of a random sample of all lung cancer cases registered for a calendar year and augmented by review of all surgical and radical radiotherapy cases. A total of 262 patients - 231 patients less than 75 years of age and 31 patients more than 75 years of age - represented 83% of the random sample. Eighty-three per cent of patients were seen within 2 weeks of referral. One-third reported symptoms occurring for less than 1 month and one-third had experienced symptoms for more than 3 months. The median time interval from first hospital contact until the making of a management decision was 18 days. The median interval from first contact to surgery was 63 days, and to starting radical radiotherapy 70 days. Histological confirmation was obtained in 69% of patients. Ten per cent of all lung cancer patients were calculated to have received chemotherapy. Five per cent of the whole cohort had definitive surgery and 64% of these were judged to be free of the disease at 3 years. Overall survival was 9% at 3 years, with no differences relating to cell type or area of residence. Many areas of good practice have been identified, but the lack of tumour staging or performance status data, the low proportion receiving chemotherapy or definitive surgery and the poor outcome after radical radiotherapy indicate the need for prospective audit and feedback of results. The long time interval from management decision to surgery and radiotherapy suggests organizational issues which need attention.
通过对一历年登记的所有肺癌病例的随机样本进行回顾性病例记录审查，并对所有手术和根治性放疗病例进行审查，确定了肺癌患者的当前治疗方法和治疗结果。共有262例患者——231例年龄小于75岁，31例年龄大于75岁——占随机样本的83%。83%的患者在转诊后2周内就诊。三分之一的患者报告症状出现时间少于1个月，三分之一的患者症状出现时间超过3个月。从首次医院接触到做出管理决策的中位时间间隔为18天。从首次接触到手术的中位间隔为63天，到开始根治性放疗的中位间隔为70天。69%的患者获得了组织学确诊。据计算，所有肺癌患者中有10%接受了化疗。整个队列中有5%的患者进行了根治性手术，其中64%的患者在3年时被判定无疾病。3年时的总生存率为9%，与细胞类型或居住地区无关。已确定了许多良好做法的领域，但缺乏肿瘤分期或体能状态数据、接受化疗或根治性手术的比例较低以及根治性放疗后的不良结果表明需要进行前瞻性审核和结果反馈。从管理决策到手术和放疗的时间间隔较长，表明存在需要关注的组织问题。
