结直肠癌就诊模式对肿瘤早期诊断的影响

目的 探讨结直肠癌就诊模式对肿瘤早期诊断的影响.方法 检索北京大学人民医院出院日期在2000年1月1日至2010年12月31之间的原发结直肠癌病例共1798例,采用系统抽样抽取符合入选标准的405例并进行回顾性研究.复习住院病历并收集病例的一般情况、肿瘤部位、TNM分期等;收集其他信息包括:(1)结直肠癌的首诊方式;(2)诊断时间:出现首发症状到确诊或高度疑诊结直肠癌的时间,包括患者费时(患者出现症状到就诊时间)和医院费时(患者首次就诊到确诊时间)两部分;(3)诊断延迟情况:按诊断时间31～60 d、61 ～90 d、91～150 d、＞150 d考虑为不同程度的诊断延迟,并分析患者因素、医院因素所起的作用;(4)结直肠癌误诊率:误诊是指结直肠癌患者被诊断为其他疾病并接受相应治疗时间＞30 d的.计数资料采用X2检验,计量资料采用t检验或非参数检验.结果 67.2％(270/402)的患者以结肠镜首次确诊结直肠癌,17.4％ (70/402)的患者以CT或B超首诊.结直肠癌的诊断时间中位数为90 d(第25％位40 d,第75％位210 d),其中患者费时及医院费时中位数分别为30和10 d.结直肠癌总误诊率为27.9％( 112/401),右半结肠(39.7％,48/121)相对左半结肠(22.9％,63/275)误诊率高(x2 =11.7,P=0.00).结直肠癌延迟诊治率(＞30 d)为77.7％ (313/403),患者因素占50.8％(156/307),医院因素占29.0％(89/307),同时存在两种因素者20.2％ (62/307);早期及晚期肿瘤诊断时间,包括患者费时和医院费时差异均无统计学意义(均P ＞0.05).诊断时间31 ～60 d、61～90 d、91～150 d、＞150 d各组患者肿瘤的TNM分期差异并无统计学意义(均P ＞0.05).结论 结肠镜是诊断结直肠癌最有效的方法.结直肠癌诊断时间中位数为90 d.诊断延迟在结直肠癌诊断中普遍存在,诊断延迟不是造成肿瘤晚期发现和预后的不良核心因素,它受肿瘤本身的生物学特性等综合因素影响.

Influences of diagnostic modes on an early diagnosis of colorectal cancer

Objective To explore the influences of diagnostic modes of colorectal cancer (CRC) on an early diagnosis of CRC.Methods A total of 405 cases were randomly collected from 1798 CRC patients registered at our hospital from January 2000 to December 2010.A retrospective chart review was undertaken for all identified cases.Besides the demographics and tumor features,TNM stage was obtained from medical records and pathological forms.Other collected data were as follows:( 1 ) Type of clinical examinations leading to diagnosis.(2) Diagnostic duration:including patient duration (period from initial symptoms to consulting a doctor and hospitalization duration ( period from patient first seeing a doctor to a confirmed CRC case).(3) Diagnostic delay and its rate:diagnostic delay was identified as the diagnostic duration of over 30 days.We compared the different delay periods of 31 -60,61 -90,91 - 150 and ＞ 150 days and its corresponding tumor stages at diagnosis.(4) Misdiagnosis and its rate:that CRC subjects were diagnosed and treated as other diseases for at least 30 days was identified as misdiagnosis.The t and Mann-Whitney U tests were performed for the quantitative data and x2 test for the qualitative data.Results Among the study subjects,67.2％ (270/402) CRC cases were examined by colonoscopy,17.4 ％ (70/402) cases by CT scan or B ultrasound.The median diagnostic duration of CRC was 90 days (25％ percentile:40 days,75％percentile:210 days).The median patient duration was 30 days and median hospital duration 10 days.The overall misdiagnostic rate of CRC was 27.9％ ( 112/401 ),higher ( 39.7％,48/121 ) in right sited CRC than in left sited CRC (22.9％,63/275 ) ( x2 =11.7,P =0.00).77.7％ (313/403) cases had ＞ 30 days diagnostic delay,50.8％ (156/307) delay attributable to the patients,while 29.0％ (89/307) attributable to hospitals and 20.2％ ( 62/307 ) attributable to both.The diagnostic duration of early-stage CRC and advanced-stage CRC appeared to be in the same length.On the other hand,no difference of TNM stage at the initial diagnosis was found in groups with different diagnostic durations of 31 - 60,61 - 90,91 - 150and ＞ 150 days (all P ＞ 0.05).Conclusion Colonoscopy is the most effective in the diagnosis of CRC.The median diagnostic time of CRC is 90 days.The phenomenon of its diagnostic delay often occurs.However,the delay is not a major cause for its advanced stage and a poor outcome.Its inherent biological characteristics may be more important.