Borowski David W, Cawkwell Sarah, Zaidi Syed M Amir, Toward Matthew, Maguire Nicola, Garg Dharmendra K, Gill Talvinder S
University Hospital North Tees , Stockton on Tees, UK.
Int J Health Care Qual Assur. 2018 Mar 12;31(2):106-115. doi: 10.1108/IJHCQA-11-2016-0169.
Purpose The NHS Bowel cancer screening programme (NHSBCSP) aims to reduce colorectal cancer (CRC) cumulative mortality by up to 23 per cent; long-term outcomes at national level are not yet known. The purpose of this paper is to examine a local population of CRC patients of screening age for their characteristics and long-term survival in relation to their presentation, including through the NHSBCSP. Design/methodology/approach Retrospective analysis of a prospectively maintained CRC database for the years 2009-2014 in a single district hospital providing bowel cancer screening and tertiary rectal cancer services. Findings Of 528 CRC patients diagnosed in the screening age range, 144(27.3 per cent) presented through NHSBCSP, 308(58.3 per cent) electively with symptoms and 76(14.4 per cent) as emergency. NHSBCSP-diagnosed patients were younger (median 66 vs 68 and 69 years, respectively, p=0.001), had more often left-sided cancers (59(41.0 per cent) vs 82(26.6 per cent) and 24(31.6 per cent), respectively, p=0.001), more UICC-stage I (42(29.2 per cent) vs 49(15.9 per cent) and 2(2.6 per cent)), stage III (59(41.0 per cent) vs 106(34.4 per cent) and 20(26.3 per cent)) and less stage IV disease (8(5.6 per cent) vs 61(19.8 per cent) and 34 (44.7 per cent), respectively, p<0.001). Three-year overall survival was best for NHSBCSP and worst for emergency patients (87.5 per cent vs 69.0 per cent and 35.3 per cent, respectively, LogRank p<0.001). Originality/value Patients diagnosed within the NHSBCSP have improved outcome compared to both symptomatic elective and emergency presentations. A reduction in overall cumulative mortality in order of 25 per cent may well be achieved, but continuing high levels of emergency presentations and undetected right-sided disease emphasise need for further improvement in public participation in the NHSBCSP and research into more sensitive and acceptable alternative screening methods.
目的 英国国家医疗服务体系（NHS）的肠癌筛查计划（NHSBCSP）旨在将结直肠癌（CRC）的累积死亡率降低多达23%；目前尚不清楚国家层面的长期结果。本文的目的是研究筛查年龄段的当地CRC患者群体的特征及其与就诊情况相关的长期生存情况，包括通过NHSBCSP就诊的患者。
设计/方法/途径 对一家提供肠癌筛查和直肠癌三级服务的单一地区医院2009 - 2014年前瞻性维护的CRC数据库进行回顾性分析。
结果 在筛查年龄范围内确诊的528例CRC患者中，144例（27.3%）通过NHSBCSP就诊，308例（58.3%）因有症状而选择就诊，76例（14.4%）为急诊就诊。通过NHSBCSP确诊的患者更年轻（中位年龄分别为66岁、68岁和69岁，p = 0.001），左侧癌症更多见（分别为59例（41.0%）、82例（26.6%）和24例（31.6%），p = 0.001），更多处于国际抗癌联盟（UICC）I期（42例（29.2%）、49例（15.9%）和2例（2.6%））、III期（59例（41.0%）、106例（34.4%）和20例（26.3%）），IV期疾病较少（分别为8例（5.6%）、61例（19.8%）和34例（44.7%），p < 0.001）。NHSBCSP确诊患者的三年总生存率最佳，急诊患者最差（分别为87.5%、69.0%和35.3%，LogRank检验p < 0.001）。
原创性/价值 与有症状的选择性就诊和急诊就诊的患者相比，在NHSBCSP内确诊的患者预后更好。很可能实现总体累积死亡率降低约25%，但急诊就诊的高比例以及未被发现的右侧疾病持续存在，凸显了进一步提高公众对NHSBCSP参与度以及研究更敏感且可接受的替代筛查方法的必要性。
