Regional variation in routes to diagnosis of cholangiocarcinoma in England from 2006 to 2017

作     者：Amy Zalin-Miller Sophie Jose Craig Knott Lizz Paley Daniela Tataru Helen Morement Mireille B Toledano Shahid A Khan 

作者机构：Department of AnalyticsHealth Data Insight CICCambridge CB215XEUnited Kingdom Disease Registration ServiceNHS EnglandLondon E144PUUnited Kingdom CEOAMMFLondon CM241QWUnited Kingdom MRC Centre for Environment and HealthSchool of Public HealthImperial College LondonLondon SW72BXUnited Kingdom Liver UnitDivision of Digestive DiseasesImperial College LondonLondon W21NYUnited Kingdom 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2023年第29卷第24期

页      面：3825-3842页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：AMMF–The Cholangiocarcinoma Charity 

主　　题：Cholangiocarcinoma Route to diagnosis Two Week Wait Emergency presentation Regional variation 

摘      要：BACKGROUND Incidence of cholangiocarcinoma(CCA)is rising,with overall prognosis remaining very *** for the high mortality of CCA include its late presentation in most patients,when curative options are no longer feasible,and poor response to systemic therapies for advanced *** presentation presents a large barrier to improving outcomes and is often associated with diagnosis via mergency presentation(EP).Earlier diagnoses may be made by Two Week Wait(TWW)referrals through General practitioner(GP).We hypothesise that TWW referrals and EP routes to diagnosis differ across regions in *** To investigate routes to diagnosis of CCA over time,regional variation and influencing *** We linked patient records from the National Cancer Registration Dataset to Hospital Episode Statistics,Cancer Waiting Times and Cancer Screening Programme datasets to define routes to diagnosis and certain patient characteristics for patients diagnosed 2006-2017 in *** used linear probability models to investigate geographic variation by assessing the proportions of patients diagnosed via TWW referral or EP across Cancer Alliances in England,adjusting for potential *** between the proportion of people diagnosed by TWW referral and EP was investigated with Spearman’s correlation *** Of 23632 patients diagnosed between 2006-2017 in England,the most common route to diagnosis was EP(49.6%).Non-TWW GP referrals accounted for 20.5%of diagnosis routes,13.8%were diagnosed by TWW referral,and the remainder 16.2%were diagnosed via an‘other’or Unknown *** proportion diagnosed via a TWW referral doubled between 2006-2017 rising from 9.9%to 19.8%,conversely EP diagnosis route declined,falling from 51.3%to 46.0%.Statistically significant variation in both the TWW referral and EP proportions was found across Cancer ***,presence of comorbidity and underlying liver disease were independently associated with both a lowe