University Hospitals Coventry and Warwickshire, Coventry, UK.
The University of Warwick, Coventry, UK.
Aliment Pharmacol Ther. 2019 Aug;50(4):348-372. doi: 10.1111/apt.15378. Epub 2019 Jul 8.
National UK data on colorectal cancer (CRC) stage at diagnosis is incomplete. Site-specific fast-track (2-week wait) cancer data are not collected directly by NHS England. Policy making based on these data alone can lead to inaccuracy.
To review available data on key outcomes (cancer conversion rate and stage at diagnosis) for the UK's lower gastrointestinal 2-week wait pathway.
A comprehensive literature search was conducted between 2000 and 2017. Primary outcomes were cancer conversion rate and cancer stage at diagnosis. Results were expressed as proportions with 95% CIs. A random effects model was used for meta-analysis; heterogeneity was assessed by I .
Of 95 papers reviewed, 49 were included in analysis with a total study population of 93,655. Cancer conversion rate was 7.7% (95% CI: 6.9-8.5). The proportion presenting at Dukes A = 11.2% (95% CI 7.4-15.6), B = 36.7% (95% CI 30.8-42.8), C = 35.7% (95% CI: 30.8-40.8) and D = 11.1% (95% CI 7.3-15.5). No colonic pathology was diagnosed in 54.6% (95% CI: 46.2-62.8).
Only 7.7% of patients referred by the 2-week wait pathway were found to have CRC. No beneficial effect on stage at diagnosis was found compared to non-2-week wait referral pathways. Over half of patients had no colonic pathology and detection of adenomas was very low. These results should prompt a reconsideration of the benefits of the 2-week wait pathway in CRC diagnosis and outcomes, with more focus on strategies to improve patient selection.
英国全国范围内有关结直肠癌（CRC）诊断时分期的数据并不完整。英格兰国民保健署并未直接收集特定部位的快速通道（2 周等待）癌症数据。仅基于这些数据制定政策可能会导致不准确。
综述英国下消化道 2 周等待通道关键结局（癌症转化率和诊断时分期）的现有数据。
对 2000 年至 2017 年间的文献进行了全面检索。主要结局是癌症转化率和诊断时癌症分期。结果以 95%置信区间（CI）表示的比例表示。使用随机效应模型进行荟萃分析；通过 I 评估异质性。
共回顾了 95 篇论文，其中 49 篇纳入分析，总研究人群为 93655 例。癌症转化率为 7.7%（95%CI：6.9-8.5）。Dukes A 分期为 11.2%（95%CI 7.4-15.6）、B 分期为 36.7%（95%CI 30.8-42.8）、C 分期为 35.7%（95%CI：30.8-40.8）和 D 分期为 11.1%（95%CI 7.3-15.5）的比例。54.6%（95%CI：46.2-62.8）的患者未发现结肠病变。
仅 7.7%通过 2 周等待通道转诊的患者被诊断为 CRC。与非 2 周等待转诊途径相比，在诊断分期方面未发现有益效果。超过一半的患者没有结肠病变，并且腺瘤的检出率非常低。这些结果应促使重新考虑 2 周等待途径在 CRC 诊断和结局方面的益处，并更加关注改善患者选择的策略。
