General practice chest X-ray rate is associated with earlier lung cancer diagnosis and reduced all-cause mortality: a retrospective observational study.
Stephen H Bradley, Richard D Neal, Matthew Ej Callister, Benjamin Cornwell, William T Hamilton, Gary A Abel, Bethany Shinkins, Richard B Hubbard, Matthew E Barclay
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引用次数: 0
Abstract
Background: Evidence is equivocal on whether general practice rates of investigation in symptomatic patients using chest X-ray (CXR) affect outcomes.
Aim: To determine whether there is an association between rates of CXR requested in general practice and lung cancer outcomes.
Design and setting: Observational study using data on English general practices.
Method: Cancer registry data for patients diagnosed with lung cancer in 2014-2018 were linked to data on general practice CXRs from 2013 until 2017. Cancer stage at diagnosis (I/II versus III/IV) and 1-year and 5-year survival rates (conditional on survival to 1 year) post-diagnosis were reported by general practice quintile of CXR rate, with adjustment for population differences (age, smoking, prevalence of chronic obstructive pulmonary disease and heart failure, ethnicity, and deprivation) and by unadjusted category (low, medium, and high).
Results: In total, 192 631 patient records and CXR rates for 7409 practices were obtained. Practices in the highest quintile of CXR rate had fewer cancers diagnosed at stage III/IV compared with those in the lowest quintile (odds ratio [OR] 0.87, 95% confidence interval [CI] = 0.83 to 0.92, P<0.001). The association was weaker for the high unadjusted CXR category (OR 0.94, 95% CI = 0.91 to 0.97). For the highest adjusted quintile, hazard ratios (HRs) for death within 1 year and 5 years were 0.92 (95% CI = 0.90 to 0.95, P<0.001) and 0.95 (95% CI = 0.91 to 0.99, P = 0.023), respectively. For the high unadjusted CXR category, the HR for 1-year survival was 0.98 (95% CI = 0.96 to 0.99, P = 0.004), with no association demonstrated for 5-year survival.
Conclusion: Patients registered at general practices with higher CXR use have a favourable stage distribution and slightly better survival. This supports the use of CXR in promoting earlier diagnosis of symptomatic lung cancer in general practice.
背景：在有症状的患者中使用胸部x线（CXR）调查的一般实践率是否影响结果的证据是模棱两可的。目的：确定全科医生（GP）要求的CXR率与肺癌结局之间是否存在关联。设计和背景：回顾性观察性研究（英国）方法：将2014-2018年诊断为肺癌的患者的癌症登记数据与2013-2017年GP cxr数据相关联。诊断阶段（I/II vs III/IV）和诊断后1年和5年生存率（以生存至1年为条件）通过患者GP的CXR率的五分位数(调整人群差异（年龄、吸烟、COPD和心力衰竭患病率、种族和贫困）和未调整的类别（低、中、高）报告。结果：共获得192,631例患者记录和7409例的CXR率。与最低的五分位数相比，最高五分位数CXR率的诊所在III/IV期诊断出的癌症较少（OR=0.87, 95% CI 0.83-0.92）。结论：在高CXR使用率的全科医生登记的患者有良好的分期分布和稍好的生存率。这支持在一般实践中使用CXR促进症状性肺癌的早期诊断。
期刊介绍：
The British Journal of General Practice is an international journal publishing research, editorials, debate and analysis, and clinical guidance for family practitioners and primary care researchers worldwide.
BJGP began in 1953 as the ‘College of General Practitioners’ Research Newsletter’, with the ‘Journal of the College of General Practitioners’ first appearing in 1960. Following the change in status of the College, the ‘Journal of the Royal College of General Practitioners’ was launched in 1967. Three editors later, in 1990, the title was changed to the ‘British Journal of General Practice’. The journal is commonly referred to as the ''BJGP'', and is an editorially-independent publication of the Royal College of General Practitioners.
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