（Lancet Oncol  IF：41.3）

• McPhail Sean,Swann Ruth,Johnson Shane A et al. Risk factors and prognostic implications of diagnosis of cancer within 30 days after an emergency hospital admission (emergency presentation): an International Cancer Benchmarking Partnership (ICBP) population-based study.[J] .Lancet Oncol, 2022, undefined: undefined.

Background 背景

Greater understanding of international cancer survival differences is needed. We aimed to identify predictors and consequences of cancer diagnosis through emergency presentation in different international jurisdictions in six high-income countries.

需要更多地了解國際癌癥生存差異。我們的目標(biāo)是通過在六個高收入國家的不同國際管轄區(qū)的緊急報告，確定癌癥診斷的預(yù)測因素和后果。

Methods 方法

Using a federated analysis model, in this cross-sectional population-based study, we analysed cancer registration and linked hospital admissions data from 14 jurisdictions in six countries (Australia, Canada, Denmark, New Zealand, Norway, and the UK), including patients with primary diagnosis of invasive oesophageal, stomach, colon, rectal, liver, pancreatic, lung, or ovarian cancer during study periods from Jan 1, 2012, to Dec 31, 2017. Data were collected on cancer site, age group, sex, year of diagnosis, and stage at diagnosis. Emergency presentation was defined as diagnosis of cancer within 30 days after an emergency hospital admission. Using logistic regression, we examined variables associated with emergency presentation and associations between emergency presentation and short-term mortality. We meta-analysed estimates across jurisdictions and explored jurisdiction-level associations between cancer survival and the percentage of patients diagnosed as emergencies.

使用聯(lián)邦分析模型，在這個以人口為基礎(chǔ)的橫斷面研究中，我們分析了來自六個國家(澳大利亞、加拿大、丹麥、新西蘭、挪威和英國)的14個轄區(qū)的癌癥登記和入院數(shù)據(jù)，包括2012年1月1日至2017年12月31日研究期間初步診斷為侵襲性食管癌、胃癌、結(jié)腸癌、直腸癌、肝癌、胰腺癌、肺癌或卵巢癌的患者。收集資料包括腫瘤部位、年齡組、性別、診斷年份和診斷分期。

急診就診被定義為在入院后30天內(nèi)診斷出癌癥。使用邏輯回歸，我們研究了與緊急情況表現(xiàn)相關(guān)的變量以及緊急情況表現(xiàn)和短期死亡率之間的聯(lián)系。我們薈萃分析了各轄區(qū)的評估數(shù)據(jù)，并探討了癌癥存活率與被診斷為急診病人百分比之間的轄區(qū)級聯(lián)系。

Findings 發(fā)現(xiàn)

In 857 068 patients across 14 jurisdictions, considering all of the eight cancer sites together, the percentage of diagnoses through emergency presentation ranged from 24·0% (9165 of 38 212 patients) to 42·5% (12 238 of 28 794 patients). There was consistently large variation in the percentage of emergency presentations by cancer site across jurisdictions. Pancreatic cancer diagnoses had the highest percentage of emergency presentations on average overall (46·1% [30 972 of 67 173 patients]), with the jurisdictional range being 34·1% (1083 of 3172 patients) to 60·4% (1317 of 2182 patients). Rectal cancer had the lowest percentage of emergency presentations on average overall (12·1% [10 051 of 83 325 patients]), with a jurisdictional range of 9·1% (403 of 4438 patients) to 19·8% (643 of 3247 patients). Across the jurisdictions, older age (ie, 75-84 years and 85 years or older, compared with younger patients) and advanced stage at diagnosis compared with non-advanced stage were consistently associated with increased emergency presentation risk, with the percentage of emergency presentations being highest in the oldest age group (85 years or older) for 110 (98%) of 112 jurisdiction-cancer site strata, and in the most advanced (distant spread) stage category for 98 (97%) of 101 jurisdiction-cancer site strata with available information. Across the jurisdictions, and despite heterogeneity in association size (I2=93%), emergency presenters consistently had substantially greater risk of 12-month mortality than non-emergency presenters (odds ratio >1·9 for 112 [100%] of 112 jurisdiction-cancer site strata, with the minimum lower bound of the related 95% CIs being 1·26). There were negative associations between jurisdiction-level percentage of emergency presentations and jurisdiction-level 1-year survival for colon, stomach, lung, liver, pancreatic, and ovarian cancer, with a 10% increase in percentage of emergency presentations in a jurisdiction being associated with a decrease in 1-year net survival of between 2·5% (95% CI 0·28-4·7) and 7·0% (1·2-13·0).

在14個司法管轄區(qū)的857068名患者中，綜合考慮所有8個癌癥部位，通過急診診斷的百分比從24.0%(38212名患者中的9165名)到42.5%(28794名患者中的12238名)。在不同司法管轄區(qū)，按癌癥部位分類的急診報告的百分比一直存在很大差異。胰腺癌的平均急診比例最高(46.1%[30972/67173])，管轄范圍為34.1%(1083/3172)~60.4%(1317/2182)。

直腸癌的平均急診比例最低(12.1%[10051/83325例])，管轄范圍為9.1%(403/4438例)至19.8%(643/3247例)。在各個司法管轄區(qū)，年齡較大(即，與年輕患者相比，75-84歲和85歲或以上)和確診時的晚期與非晚期相比，急診表現(xiàn)的風(fēng)險一直較高，112個轄區(qū)癌癥部位層中110個(98%)的急診表現(xiàn)百分比最高，101個轄區(qū)癌癥部位層中98個(97%)的急診表現(xiàn)百分比最高。在不同司法管轄區(qū)，盡管關(guān)聯(lián)規(guī)模不同(I2=93%)，急診呈現(xiàn)者持續(xù)12個月死亡的風(fēng)險顯著高于非急診呈現(xiàn)者(112個轄區(qū)-癌癥部位地層中112個[100%]的優(yōu)勢比>1.9，相關(guān)95%CI的最小下限為1.26)。在結(jié)腸癌、胃癌、肺癌、肝臟、胰腺癌和卵巢癌患者中，轄區(qū)一級急診病例的百分比與轄區(qū)一級1年生存率呈負(fù)相關(guān)，一個轄區(qū)內(nèi)急診病例百分比增加10%與1年凈生存率下降2.5%(95%可信區(qū)間0·28-4.7)至7.0%(1.2-13.0)相關(guān)。

Interpretation 解釋

Internationally, notable proportions of patients with cancer are diagnosed through emergency presentation. Specific types of cancer, older age, and advanced stage at diagnosis are consistently associated with an increased risk of emergency presentation, which strongly predicts worse prognosis and probably contributes to international differences in cancer survival. Monitoring emergency presentations, and identifying and acting on contributing behavioural and health-care factors, is a global priority for cancer control.

在國際上，相當(dāng)大比例的癌癥患者是通過急診確診的。特定類型的癌癥、年齡較大和確診時處于晚期的癌癥與急診表現(xiàn)的風(fēng)險增加一致，這強烈地預(yù)示著更差的預(yù)后，并可能導(dǎo)致癌癥存活率的國際差異。監(jiān)測緊急情況，確定有助于行為和保健的因素并采取行動，是癌癥控制的全球優(yōu)先事項。