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。

Impact of delay in diagnosis and treatment on the prognosis of lung cancer

OBJECTIVE:To evaluate the relationship between delay and prognosis in patients with advanced lung cancer and to investigate the delay time from first symptom and from first hospital presentation to start of treatment. METHODS: Two types of delay (SPD and PTD) were investigated in 484 patients treated for advanced lung cancer. Delays in relation to clinical characteristics were compared and the effects of delays and other relevant factors on survival were also assessed. RESULTS: The median SPD was 2.0 months and PTD 0.5 months. not influenced by sex,age, staging and first symptom (P>0.05). SPD,PTD, age, TNM stages and pathological types was tested by COX proportional risk model analysis . TNM stage is an independent factor indicating for poor prognosis (with very significant statistical differences). PTD is another independent factor influencing patient's survival (P<0.01). For the wald analysis of stages and PTD, the P<0.05. These results indicates that the longer PTD and higher stages, the higher risk for poor prognosis (death rate). The patients were stratified based on median PTD of 14 days (0.5 month). in all 484 cases, the P=0.047 for the differences between PTD less than 14 days and PTD over 14 days. CONCLUSION: PTD is independent factors influencing prognosis of advanced lung cancers. Therefore, improvements in our medical policies, medical treatment availability and shorten the waiting time for treatment are effective ways to improve the survival of advanced stage lung cancers.