Clinical intervals and diagnostic characteristics in a cohort of prostate cancer patients in Spain: a multicentre observational study

BMC Urology

Research

José Ignacio Emparanza¹  María Morales Suárez-Varela²  Javier de la Cruz³  Montserrat Ferrer⁴  María José Martinez-Zapata⁵  Xavier Bonfill⁶  María José Sánchez⁷  Víctor Abraira⁸  Javier Zamora⁸  José Ignacio Pijoán⁹  Stefanie Schmidt^1,10  Juan M. Ramos-Goñi^1,11  Robin WM Vernooij^1,12  Joan Palou^1,13 

[1] CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain;Clinical Epidemiology Unit, Hospital Universitario Donostia, BioDonostia, San Sebastian, Spain;CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain;Department of Preventive Medicine, Unit of Public Health and Environmental Care, University of Valencia, Center for Public Health Research (CSISP), Valencia, Spain;CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain;Hospital 12 de Octubre, Madrid, Spain;CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain;IMIM (Hospital del Mar Medical Research Institute), Health Services Research Group, Barcelona, Spain;CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain;Institute of Biomedical Research (IIB Sant Pau), Iberoamerican Cochrane Centre, Barcelona, Spain;Universitat Autònoma de Barcelona, Barcelona, Spain;CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain;Institute of Biomedical Research (IIB Sant Pau), Iberoamerican Cochrane Centre, Barcelona, Spain;Universitat Autònoma de Barcelona, Barcelona, Spain;Public Health and Clinical Epidemiology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain;Instituto de Investigación Biosanitaria de Granada, Escuela Andaluza de Salud Pública, Granada, Spain;CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain;Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain;CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain;Unidad de Epidemiología Clínica y Soporte Metodológico, UICEC de BioCruces-SCReN, Barakaldo, Spain;Department of Experimental and Health Sciences, Universidad Pompeu Fabra (UPF), Barcelona, Spain;Health Services Research on Chronic Patients Network (REDISSEC), HTA Unit of the Canary Islands Health Service (SESCS), S/C de Tenerife, La Laguna, Spain;Institute of Biomedical Research (IIB Sant Pau), Iberoamerican Cochrane Centre, Barcelona, Spain;Universitat Autònoma de Barcelona, Barcelona, Spain;Fundació Puigvert, Barcelona, Spain;

关键词: Prostatic neoplasms;    Male urogenital diseases;    Multicentre study;    Cohort study;    Prospective study;   

DOI  :  10.1186/s12894-015-0058-x

 received in 2014-06-18, accepted in 2015-06-16,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundLittle is known about the healthcare process for patients with prostate cancer, mainly because hospital-based data are not routinely published. The main objective of this study was to determine the clinical characteristics of prostate cancer patients, the, diagnostic process and the factors that might influence intervals from consultation to diagnosis and from diagnosis to treatment.MethodsWe conducted a multicentre, cohort study in seven hospitals in Spain. Patients’ characteristics and diagnostic and therapeutic variables were obtained from hospital records and patients’ structured interviews from October 2010 to September 2011. We used a multilevel logistic regression model to examine the association between patient care intervals and various variables influencing these intervals (age, BMI, educational level, ECOG, first specialist consultation, tumour stage, PSA, Gleason score, and presence of symptoms) and calculated the odds ratio (OR) and the interquartile range (IQR). To estimate the random inter-hospital variability, we used the median odds ratio (MOR).Results470 patients with prostate cancer were included. Mean age was 67.8 (SD: 7.6) years and 75.4 % were physically active. Tumour size was classified as T1 in 41.0 % and as T2 in 40 % of patients, their median Gleason score was 6.0 (IQR:1.0), and 36.1 % had low risk cancer according to the D’Amico classification. The median interval between first consultation and diagnosis was 89 days (IQR:123.5) with no statistically significant variability between centres. Presence of symptoms was associated with a significantly longer interval between first consultation and diagnosis than no symptoms (OR:1.93, 95%CI 1.29–2.89). The median time between diagnosis and first treatment (therapeutic interval) was 75.0 days (IQR:78.0) and significant variability between centres was found (MOR:2.16, 95%CI 1.45–4.87). This interval was shorter in patients with a high PSA value (p = 0.012) and a high Gleason score (p = 0.026).ConclusionsMost incident prostate cancer patients in Spain are diagnosed at an early stage of an adenocarcinoma. The period to complete the diagnostic process is approximately three months whereas the therapeutic intervals vary among centres and are shorter for patients with a worse prognosis. The presence of prostatic symptoms, PSA level, and Gleason score influence all the clinical intervals differently.

【 授权许可】

Unknown   
© Bonfill et al. 2015. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.