原发性肺癌患者诊断延迟的影响因素分析

目的：分析原发性肺癌诊断延迟的相关因素,提出对策,降低肺癌患者的诊断延迟率。方法：回顾性分析2002年1月1日～2006年12月31日经住院诊断为原发性肺癌353例患者的病情资料。结果：353例中一半出现症状后及时就诊而在4周内（中位数）被推荐专科诊治。85．1％的患者在收到转诊信的1周内于专科诊治（BTS建议为100％）。100％的患者自收到转诊信后在2周内明确诊断并被告知（BTS建议为100％）。96．5％的患者在首次专科就诊3周内开始接受治疗（SLCG建议为80％）。结论：本研究的结果和国外学者的研究有较好的比较,但是患者诊断延迟的中位数和均数分别接近4周和6周,仍需缩短延迟时间。有效措施包括：加强对患者健康宣教,完善高危人群筛查,及时转入专科诊治,并从制度上落实。     

青年人肺癌的诊断与治疗

目的 :研究青年人肺癌的致病因素、临床特点及治疗方法。方法 :回顾性分析 1985年 1月 -2 0 0 0年 1月 ,手术治疗并经病理诊断的≤ 4 0岁青年人肺癌 67例。对其临床特点、误诊原因、手术及预后进行总结。结果 :按TNM分期 :Ⅱ期 17例、Ⅲ期 4 1例、Ⅳ期 9例。病理类型 :腺癌和小细胞癌达67 2 % (45 67)。术前 4 1例曾误诊误治。全部经手术治疗 ,34例行根治手术 ,2 0例行姑息手术 ,13例行剖胸探查。 1年、3年、5年存活率分别为 73 1%、4 6 3%、2 5 4 %。结论 :青年人肺癌就诊时多为晚期 ,生物学行为较差 ,早期诊治是提高生存的根本措施。综合治疗可提高疗效     

青年肺癌与老年肺癌临床分析

回顾性分析 1992～ 2 0 0 1年收治的≤ 40岁肺癌 40例及近 5年收治的≥ 6 0岁肺癌 90例临床资料。结果青年肺癌与老年肺癌分别占同期肺癌的 10 6 %及 6 9 2 % ,临床表现均以咳嗽、胸痛、咯血、胸闷为多见 ,青年肺癌以腺癌居多、未分化癌次之 ,而老年肺癌则以鳞癌为多 ,腺癌次之 ,且青年组首发症状至就诊时间短、较早发生胸膜及全身转移、预后差 ,此外老年肺癌的发生还与吸烟有关。     

青年肺癌的临床特点及误诊原因分析--附32例报告

对32例青年肺癌临床表现及误诊原因进行分析,发现青年肺癌误诊率高,为87.5%(28/32).误诊疾病的频次依次为肺结核、肺炎、胸膜炎等.误诊的主要原因是首诊医生对青年肺癌的临床特点缺乏充分的认识.     

早期中心型肺癌的发现与诊断

27例病理证实的早期中心型肺癌早期症状为痰血、干咳、低热者分别为 63 %、2 9 6%和 7 4%。以上三症状成为早期中心型肺癌的重要信号。X线表现为段性肺炎、肺不张、肺门影增浓和局限性肺气肿者占 63 %、X线阴性者占 3 7%。早期中心型肺癌最有价值诊断方法是纤维镜和痰脱落细胞检查 ,其阳性率为 10 0 %和 81 5 %。     

肺癌流行病学和早期诊断新技术

肺癌是当今世界各国常见的恶性肿瘤 ,并已成为癌症死亡的主要原因。 2 0 0 0年美国新发病例达 16 94万人 ,近年来通过采用控制吸烟及大气污染等措施 ,发达国家的肺癌发病率有所下降 ,但我国肺癌发病率及死亡率仍占据首位。原发性肺癌的早期诊断非常重要 ,临床诊疗技术和先进仪器的使用有助于早期发现肺癌。就低剂量螺旋CT、荧光支气管镜、CT PET等在肺癌早期诊断中的应用及进展。     

老年人肺癌320例分析

目的 :研究老年人肺癌的临床特点、误诊原因及治疗方法。方法 :回顾性分析 1980～ 1999年收治的≥ 60岁肺癌 32 0例临床资料。结果 :老年人肺癌占同期肺癌的 38.0 % ,男女之比为 3∶1。临床表现以咳嗽 ( 82 .8% )、咯血 ( 4 1.0 % )、胸痛 ( 2 6.9% )、胸闷 ( 36.6% )常见 ,全身症状 75.5%和肺外表现4 3 4 %亦多见。误诊原因主要是肺外症状多、伴随基础病多、辅助检查无特异性。老年人肺癌总的 5年生存率 15.6% ,综合治疗、单纯手术、放疗、化疗及其他治疗 5年生存率分别为 30 .0 %、2 0 .0 %、5.6%、0、0。结论 :老年人肺癌发病率高 ,女性发病率上升应重视 ,掌握其临床特点 ,结合合理的辅助检查可望减少误诊。治疗方法以手术为主的综合治疗为首选。     

67Ga-枸橼酸盐用于肺癌显像的诊断分析

目的　探讨６７Ｇａ－枸橼酸盐在肺癌诊断中的应用价值。方法　对１８４ 例住院病人进行了６７Ｇａ的胸部显像。病人均经穿刺活组织检查,手术切除或其他方法获得病理结果,其中肺癌１２７例,良性病变５７ 例。结果　在１２７ 例肺癌中,６７Ｇａ显像阳性１０１ 例,显像阴性２６ 例;５７ 例良性病人中,阳性１２ 例,阴性４５ 例。６７ Ｇａ在肺癌诊断中的显像灵敏度、特异性和准确率分别为７９．５％ 、７８．９％ 和７９．３％ 。阳性预测率８９．４％ ,阴性预测率６３．３％ 。其灵敏度与肿瘤类型及肿块大小有关。结论　６７Ｇａ——枸橼酸盐在用于肺部疾病,尤其在肺癌诊断中具有较好的应用价值。     

纤维支气管镜检查诊断肺癌的经验体会

对 40 0例临床疑诊为肺癌的患者进行纤支镜检查 ,病理诊断证实肺癌 336例。提示纤支镜检查在肺癌临床早期诊断中的价值     

Multiple markers for lung cancer diagnosis: validation of models for advanced lung cancer

Sera from 171 patients with advanced lung cancer, from 110 normals, and from 123 subjects with benign respiratory diseases were analyzed for 10 substances to detect lung cancer: ferritin, lipid-bound sialic acid, total sialic acid, beta 2-microglobulin, lipotropin, the alpha and beta subunits of human chorionic gonadotropin, calcitonin (two assays), parathyroid hormone, and carcinoembryonic antigen. Individual markers were studied, and optimal combinations of markers were sought for discriminating lung cancer patients from normals and from patients with benign lung disease. Numerous methods for combining the markers were examined, but the methods of logistic regression and recursive partitioning were finally adopted. The best discrimination rules we could find used only carcinoembryonic antigen (CEA) and total sialic acid (TSA). The performance of these rules was validated on an independent serum panel containing sera from 68 patients with advanced lung cancer, from 40 normals, and from 52 patients with benign respiratory disease. The combination rules based on TSA and CEA performed better than a rule based on CEA alone. Logistic discrimination rules with TSA and CEA that were designed to have 95% specificity achieved 54% sensitivity for discriminating advanced lung cancer from normal controls and 52% sensitivity for discriminating advanced lung cancer from controls with benign disease. Some aspects of clinical applicability are discussed, including planned studies for localized lung cancer and the requirement for further testing in specific clinical settings.     

Impact of delay on diagnosis and treatment of primary lung cancer

Lung cancer continues to be a devastating disease that defies nearly all the therapeutic endeavours to improve the 5-year survival. Survival is determined to a large extent by age, morphology and stage. Early presymptomatic detection by screening has as yet failed to demonstrate any effect of such programmes. At the moment, medical healthcare units invest a significant proportion of their resources to eliminating waiting times in diagnosis and treatment in order to improve outcome. The aim of this literature review is to investigate whether waiting times and delays have any bearing on prognosis and treatment. Specifically, the hypothesis is raised that longer delays are associated with poorer survival or more advanced stage disease and may explain the poorer survival rate. Large-scale cohort studies within well-defined catchment areas are required both to establish the prognostic impact of delays and to understand the natural progression of lung cancers.     

肺癌患者就诊及治疗延迟对预后的影响

目的探讨就诊与治疗延迟的时间对肺癌预后的影响。方法收集484例肺癌患者临床资料进行统计学分析,将出现首发症状到就诊的时间定义为就诊延迟(SPD),就诊到接受治疗的时间定义为治疗延迟(PTD),分析其相关因素及对预后的影响。结果484例肺癌患者,中位SPD的时间为2.0个月,PTD的时间为0.5个月,四分位间距分别为2.0和0.4,将所有病例按照性别、年龄、TNM分期和首发症状(咳嗽、痰血和胸痛)进行分组,各组就诊、治疗延迟的时间差异无统计学意义,P>0.05,即SPD和PTD与性别、年龄、分期和首发症状无关。将SPD、PTD、年龄、TNM分期和病理分型引入COX比例风险模型分析,显示TNM分期及PTD模型,P<0.01,是独立的预后不良因素。自变量临床分期和PTD用wald检验,P<0.05,由模型可得PTD时间越长分期越高,风险率即死亡率就越高。PTD小于中位数和PTD大于中位数的两组比较,差异有统计学意义,P=0.047。结论PTD是影响肺癌预后的独立因素,因此完善我们的医疗体系、提高医疗水平、缩短患者等待诊断及治疗的时间是提高肺癌患者生存期的有效途径。     

Determinants of delay for breast cancer diagnosis

BACKGROUND: A study was conducted to identify determinants of diagnostic delay in order to develop strategies to reduce the waiting time for breast cancer diagnosis. METHODS: A cohort of 696 women diagnosed with early breast cancer was recruited in two radiation oncology centers of Quebec, Canada, in 2002-2003. A structured questionnaire was administered to identify potential determinants of diagnostic delay. Dates for all of the breast procedures were extracted from medical records. "Diagnostic delay" was defined as a time interval of more than 5 weeks between the first breast specific procedure and the final diagnostic procedure. A logistic regression model was used to estimate adjusted odds ratios (OR) of diagnostic delay and their 95% confidence intervals (CI). RESULTS: The two main determinants of diagnostic delay were the medical indication for the breast investigation and the scheduling of the diagnostic procedures. Compared to screened women, those referred because of clinical findings had an OR of diagnostic delay of 0.34 (95% CI=0.22-0.54). Women who underwent breast procedures during visits on at least four separate days had an OR of 6.31 (95% CI=3.85-10.34) compared to those who completed their investigation during visits on at most two separate days. Women who had complementary procedures the day of the first procedure were less likely to experience a diagnostic delay (OR=0.51, 95% CI=0.31-0.82). Finally, diagnostic delay was also significantly associated with the interpretation of the first diagnostic procedure, type of final diagnostic procedure, size of tumor, and family income. CONCLUSIONS: This study suggests that a promising strategy for reducing the waiting time for breast cancer diagnosis is to better integrate the services during the investigation period.     

MEP therapy of advanced lung cancer

Fourty-four patients with advanced non-small cell cancer of the lung were treated with a combination chemotherapy of mitomycin C, endoxan, and cisplatin (MEP). The overall response rate was 20%, with 9 partial responses. The median duration of response was 7 months. The overall median survival was 10 months. No significant difference was noted in survival time between PR and NC. MEP therapy seems to provide a relatively easy therapeutic approach in the treatment of advanced lung cancer with no associated renal toxicity or loss of hair.