School of Public Health, Fudan University, 130 Dong'an Rd, Shanghai, 200032, China.
Center for Disease Control and Prevention, Pudong New Area, Shanghai, 200136, China.
BMC Public Health. 2019 Jul 29;19(1):1016. doi: 10.1186/s12889-019-7318-8.
Shanghai is one of the earliest cities in developing countries to introduce an organized colorectal screening program for its residents to fight against the rising disease burden of colorectal cancer (CRC). This study aims to investigate the impact of the Shanghai screening program implemented in 2013 on the survival rates of CRC patients.
We calculated up to 5-year survival rates for 18,592 CRC patients from a representative district of Shanghai during 2002-2016, using data from the Shanghai Cancer Registry. We performed joinpoint regressions to examine temporal changes in the trends of the CRC survival rates. We then conducted Kaplan-Meier and Cox proportional hazards modelling to study the association of the survival rates with screening behaviors of the patients. In all the model specifications, we took into account the gender, age and TNM stage at diagnosis, and level of treatment hospital of the patients.
We find that the annual percentage changes of the survival rates increased faster after somewhere around 2013, however, the differential trends were not significant. Results from the Cox multivariate regression analysis suggest that patients who did not participate in the screening program showed significantly lower cancer-specific survival (hazard ratio (HR) = 1.46; 95% confidence interval (CI): 1.12-1.91) and all-causes survival (HR = 1.37; 95% CI: 1.05-1.77), compared to those who did. Among program participants, delayed colonoscopy was associated with poor cancer-specific survival (hazard ratio (HR) = 2.93; 95% confidence interval (CI): 1.64-5.23) and all-causes survival (HR = 3.29; 95% CI: 1.85-5.84).
Screening participation and high level of colonoscopy compliance can improve the survival of CRC participants.
上海是发展中国家最早为居民开展有组织结直肠癌筛查项目的城市之一，以应对结直肠癌（CRC）发病率不断上升的问题。本研究旨在调查 2013 年实施的上海筛查项目对 CRC 患者生存率的影响。
我们利用上海癌症登记处的数据，计算了 2002 年至 2016 年期间上海某代表性地区的 18592 例 CRC 患者的 5 年生存率。我们采用 Joinpoint 回归分析检测 CRC 生存率趋势的时间变化。然后，我们采用 Kaplan-Meier 和 Cox 比例风险模型研究患者的生存率与筛查行为之间的关联。在所有模型中，我们考虑了患者的性别、年龄和诊断时的 TNM 分期以及治疗医院的级别。
我们发现，2013 年前后，生存率的年变化率增加得更快，但差异趋势并不显著。Cox 多变量回归分析的结果表明，未参加筛查项目的患者癌症特异性生存率（危险比（HR）=1.46；95%置信区间（CI）：1.12-1.91）和全因生存率（HR=1.37；95% CI：1.05-1.77）显著较低。在项目参与者中，延迟结肠镜检查与较差的癌症特异性生存率（HR=2.93；95% CI：1.64-5.23）和全因生存率（HR=3.29；95% CI：1.85-5.84）相关。
筛查参与和高结肠镜检查依从性可以提高 CRC 参与者的生存率。
