Singh Harminder, Shu Emma, Demers Alain, Bernstein Charles N, Griffith Jane, Fradette Katherine
Department of Epidemiology and Cancer Registry, Winnipeg, Manitoba.
Can J Gastroenterol. 2012 Dec;26(12):877-80. doi: 10.1155/2012/363242.
There has been a rapid increase in screening for colorectal cancer (CRC) over the past several years in North America. This could paradoxically lead to worsening outcomes if the system is not adapted to deal with the increased demand. For example, this could create increased wait times for endoscopy and delayed time to CRC diagnosis, which could worsen clinical outcomes such as stage at diagnosis and⁄or survival. No previous Canadian study has evaluated the association between time to CRC diagnosis and clinical outcomes.
The present historical cohort study used Manitoba's population-based cancer registry and Manitoba Health administrative databases. The effect of time to diagnosis on patient survival was evaluated using Cox regression analysis with adjustment for stage at diagnosis, grade of CRC, age, sex, socioeconomic status, comorbidity index score and year of CRC diagnosis. The association between time to diagnosis and CRC stage at diagnosis was evaluated using multivariate logistic regression analysis.
The median time to CRC diagnosis increased significantly from 72 days (95% CI 61 days to 83 days) in 2004 to 105 days (95% CI 64 days to 129 days) in the first three months of 2009 (P=0.04). There was no significant association between time to diagnosis and survival. Individuals with the longest time to diagnosis were less likely to have stage III⁄IV CRC at diagnosis (quartile 4 versus quartile 1: OR 0.50 [95% CI 0.33 to 0.75).
Time to CRC diagnosis is continuing to increase in Manitoba. Although the present study did not detect a significant negative clinical effect of increasing time to diagnosis, additional studies are required.
在过去几年中，北美地区对结直肠癌（CRC）的筛查迅速增加。如果系统不能适应需求的增加，这可能会导致矛盾的结果，即情况恶化。例如，这可能会增加内镜检查的等待时间，并延迟结直肠癌的诊断时间，从而可能使诸如诊断时的分期和/或生存率等临床结果恶化。此前尚无加拿大的研究评估结直肠癌诊断时间与临床结果之间的关联。
本历史性队列研究使用了曼尼托巴省基于人群的癌症登记处和曼尼托巴省卫生管理数据库。采用Cox回归分析评估诊断时间对患者生存的影响，并对诊断时的分期、结直肠癌分级、年龄、性别、社会经济地位、合并症指数评分和结直肠癌诊断年份进行了调整。采用多变量逻辑回归分析评估诊断时间与诊断时结直肠癌分期之间的关联。
结直肠癌诊断的中位时间从2004年的72天（95%CI为61天至83天）显著增加到2009年前三个月的105天（95%CI为64天至129天）（P=0.04）。诊断时间与生存率之间无显著关联。诊断时间最长的个体在诊断时患III/IV期结直肠癌的可能性较小（四分位数4与四分位数1相比：OR 0.50[95%CI 0.33至0.75]）。
在曼尼托巴省，结直肠癌的诊断时间持续增加。尽管本研究未发现诊断时间增加会产生显著的负面临床影响，但仍需要进一步的研究。
