Delays in diagnosis and time to diagnosis generally are used interchangeably in cancer disparity research, but these terms may have important differences. Although these terms are related, we hypothesize that time to diagnosis is determined by the aggressiveness of the tumor based on intrinsic factors such as tumor biology, whereas delays in diagnosis are caused by extrinsic factors such as socioeconomic status, leading to presentation at higher stage of disease due to barriers of care. We conducted a retrospective study of 306 patients diagnosed with Wilms tumor at Children's Hospital Colorado between 1971 and 2016 identifying patient barriers as extrinsic markers and using unfavorable histology and loss of heterozygosity as markers of aggressive tumor biology. Multivariable logistic regression was performed. Patients with Medicaid were more likely to present greater than 4 days after initial symptoms compared to those with private insurance, and those with housing concerns were more likely to be diagnosed greater than 9 days from initial symptoms. Tumor biology was noted to be associated with higher stage at diagnosis, but patient barriers were not. These findings suggest the interplay between tumor biology, patient barriers, diagnostic timing, and stage at diagnosis is more complex, multifactorial, and in need of further study.

中文翻译：

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研究肿瘤生物学和社会决定因素对肾母细胞瘤诊断时间和分期的影响。

诊断延迟和诊断时间通常在癌症差异研究中可互换使用，但这些术语可能存在重要差异。尽管这些术语是相关的，但我们假设诊断时间是由基于肿瘤生物学等内在因素的肿瘤侵袭性决定的，而诊断延迟是由社会经济地位等外在因素引起的，导致出现在更高的阶段由于护理障碍而导致的疾病。我们对 1971 年至 2016 年间在科罗拉多州儿童医院诊断为肾母细胞瘤的 306 名患者进行了一项回顾性研究，将患者障碍识别为外在标记，并使用不利的组织学和杂合性丧失作为侵袭性肿瘤生物学的标记。进行多变量逻辑回归。与拥有私人保险的患者相比，参加医疗补助的患者更有可能在出现症状后 4 天以上出现症状，而有住房问题的患者更有可能在出现症状后 9 天以上被诊断出来。肿瘤生物学被认为与诊断时的较高阶段有关，但患者障碍却并非如此。这些发现表明肿瘤生物学、患者障碍、诊断时机和诊断阶段之间的相互作用更加复杂、多因素，需要进一步研究。