HER2阳性乳腺癌患者延迟确诊对确诊分期影响的研究

Association between delays in diagnosis and clinical stage of HER2-positive breast cancer

目的 探讨人表皮生长因子受体2(HER2)阳性乳腺癌患者首次出现症状至乳腺癌确诊的时间间隔对确诊时肿瘤分期的影响。方法 研究对象来源于2013-12-01-2020-12-31在福建省肿瘤医院确诊为HER2阳性的女性乳腺癌患者。基于病历数据回顾性收集有完整首次出现症状时间、确诊时间、确诊时分期和社会人口学资料的患者。采用二分类logistic回归模型分析乳腺癌患者从首次出现症状至确诊时长对确诊时分期的影响。结果 1 332例HER2阳性乳腺癌患者首次出现症状至确诊的中位数时长为46 d。确诊分期为Ⅰ和Ⅱ期的共827例(62.09%),Ⅲ期505例(37.91%)。单因素分析结果表明,首次出现症状至确诊时长<46 d的患者中,确诊为Ⅲ期的比例(41.58%,210/505)低于≥46 d的患者(58.42%,295/505),差异有统计学意义,χ^(2)=24.718,P<0.001。控制可能存在的混杂因素后,以首次出现症状至确诊的时长<46 d为参照,≥46 d的患者确诊时是Ⅲ期的风险更高(OR=1.78,95%CI:1.42~2.23)。结论 延迟确诊的HER2阳性乳腺癌患者确诊时肿瘤分期晚的可能性更大。应通过改善可干预因素促进患者尽早就医,以期提前患者的确诊分期,从而提高生存率。

Objective To investigate the association between the duration of diagnosis delay and the clinical stage of patients with human epidermal growth factor receptor 2(HER2) positive breast cancer.The length of delay was defined as the number of days from the date of breast symptom onset to the date of tumor stage confirmation.Methods The analyses targeted at patients with HER2 positive breast cancer under treatment in Fujian Cancer Hospital from December 1,2013 to December 31,2020.We extracted demographic and socioeconomic information, the dates of breast cancer symptom onset, time of diagnosis,,and tumor stage at diagnosis of the patients from the hospital information system as we retrospectively collected their medical records.The binary logistic regression model was used to analyze the influence of the time from the first symptom to the diagnosis of breast cancer on the stage of diagnosis.Results A total of 1 332 patients were included in our analysis.The median length of diagnosis delay was 46 days.62.09%(827/1 332) of the patients with HER2 positive breast cancer were diagnosed as stage Ⅰ or Ⅱ,and 37.91%(505/1 332) were stage Ⅲ.The results of univariate analysis showed that the proportion of patients diagnosed as stage Ⅲ(41.58%,210/505) in the period from the first symptom to diagnosis <46 days was lower than that in patients whose length of diagnosis delay≥46 days(58.42%,295/505),the difference was statistically significant(χ^(2)=24.718,P<0.001).In the adjusted analyses,compared with the delays of<46days,patients with delays of≥46days were more likely to have stageⅢ disease at diagnosis(OR=1.78,95%CI:1.42-2.23).Conclusions The delays in diagnosis increase the likelihood of more advanced-stage presentations among patients with HER2-positive breast cancer.It suggests that we should take measures to encourage patients to seek medical treatment as soon as possible,so as to reduce the staging at diagnosis,thus,improve the survival rate.