Background: Accurate and timely molecular testing in patients with non-small cell lung cancer (NSCLC) is mandatory for targeted therapies and improved outcomes. Real-world obstacles, including geographic distance from specialized lung cancer services, along with comorbidities, may delay molecular diagnosis and subsequent treatment, therefore hampering survival.Methods: We conducted a retrospective, multi-departmental observational study of 927 patients with newly diagnosed NSCLC that were referred to a tertiary hospital in western Greece between January 2021 and December 2024. Patients were classified based on distance of residence (<30 km vs. ≥30 km). Clinical characteristics, time elapsed from pathological to final molecular diagnosis, and survival outcomes were analyzed and compared. Multivariable Cox regression was used to identify independent predictors of overall survival. Results: Patients residing ≥30 km away (61.2%) experienced delays in molecular testing (median 31 vs. 26 days,p= 0.002) and were less likely to undergo such testing (p= 0.012) compared to those residing <30km. Patients residing >30 km also had a higher prevalence of COPD (42.5% vs. 31.2%,p= 0.002). Median survival from initial pathological diagnosis to death was significantly shorter in non-urban patients (129 vs. 215 days,p= 0.010). A molecular testing delay >35 days was independently associated with worse survival (HR = 0.684, 95% CI: 0.508–0.923,p= 0.013). No differences in TNM stage distribution were observed between geographical groups. Conclusions: Geographic disparities significantly impact access to advanced lung cancer services and molecular diagnostics and may provisionally affect prognosis in NSCLC. Improving testing pathways, incorporating reflex testing in pathological molecular analysis, and optimizing referral systems in rural areas may help to reduce inequalities and improve patient outcomes.
背景：对非小细胞肺癌（NSCLC）患者进行准确、及时的分子检测是实施靶向治疗和改善预后的必要条件。现实中的障碍，包括与专业肺癌诊疗机构的地理距离以及合并症的存在，可能延迟分子诊断及后续治疗，从而影响患者生存。 方法：本研究对2021年1月至2024年12月期间转诊至希腊西部一家三级医院的927例新诊断NSCLC患者进行了回顾性、多科室观察性研究。根据居住距离（<30公里 vs. ≥30公里）对患者进行分类。分析并比较了患者的临床特征、从病理诊断到最终分子诊断的时间间隔以及生存结局。采用多变量Cox回归分析确定总生存期的独立预测因素。 结果：与居住距离<30公里的患者相比，居住距离≥30公里的患者（占61.2%）在分子检测方面存在延迟（中位时间31天 vs. 26天，p=0.002），且接受此类检测的可能性更低（p=0.012）。居住距离>30公里的患者慢性阻塞性肺疾病患病率也更高（42.5% vs. 31.2%，p=0.002）。非城市患者从初始病理诊断到死亡的中位生存期显著更短（129天 vs. 215天，p=0.010）。分子检测延迟超过35天与较差的生存期独立相关（HR = 0.684，95% CI: 0.508–0.923，p=0.013）。不同地理分组间的TNM分期分布未见差异。 结论：地理差异显著影响患者获得先进的肺癌诊疗服务和分子诊断的机会，并可能暂时性影响NSCLC患者的预后。优化检测流程、在病理分子分析中纳入反射性检测以及完善农村地区的转诊系统，可能有助于减少不平等并改善患者结局。
肿瘤(癌症)患者之家