对意大利北部某地区结直肠癌筛查计划影响的综合评估。
A comprehensive assessment of the impact of a colorectal cancer screening program in a northern Italian area.
机构信息
Governance Department, Azienda Provinciale per i Servizi Sanitari, Viale Degasperi 79, Trento Italy.
Department of Clinical and Evaluative Epidemiology, Azienda Provinciale per i Servizi Sanitari, Viale Verona, Trento, Italy.
出版信息
Dig Liver Dis. 2022 Mar;54(3):400-406. doi: 10.1016/j.dld.2021.03.016. Epub 2021 Apr 11.
BACKGROUND
The impact of a faecal immunochemical test-based colorectal cancer (CRC) screening program in terms of patient prognosis could be affected by lead-time bias, which artificially increases the survival of screen-detected patients due to the early diagnosis.
AIMS
To provide a description of the impact of the CRC screening program in the Trentino Region (Italy), including the Cure Fraction (CF), a prognostic indicator not affected by lead-time bias.
METHODS
The program started in 2008, inviting the resident population aged 50-69 years. In this retrospective cohort study, 1,697 CRC diagnosed between 2003 and 2014 in patients aged 50-69 years were classified as pre-screening (PS), screen-detected (SD), interval cancers (IC) and not-screen-detected (NSD). We compared groups by stage at diagnosis and CF. Trends in CRC mortality were reported.
RESULTS
The proportion of stage I among SD cases was 51%, higher than PS (19%; OR 4.66, 95%CI 3.50-6.20), NSD (20.6%; OR 3.96, 95%CI 2.95-5.32) and IC (33.3%; OR 2.11, 95%CI 1.10-4.04). The CF of PS, NSD and SD cases was respectively 57% (95%CI 54-60%), 60% (95%CI 58-63%) and 93% (95%CI 89-96%). CRC mortality dropped from 40.7 to 25.6\100,000.
CONCLUSION
The program significantly improved the prognosis of patients, decreasing CRC mortality and incidence of advanced CRCs.
背景
基于粪便免疫化学试验的结直肠癌（CRC）筛查计划对患者预后的影响可能受到领先时间偏倚的影响，由于早期诊断，这种偏倚会人为地增加筛查发现的患者的生存率。
目的
描述特伦蒂诺地区（意大利）的 CRC 筛查计划的影响，包括不受领先时间偏倚影响的预后指标治愈率（CF）。
方法
该计划于 2008 年启动，邀请 50-69 岁的居民参加。在这项回顾性队列研究中，将 2003 年至 2014 年间 50-69 岁诊断为 CRC 的 1697 例患者分为筛查前（PS）、筛查发现（SD）、间隔癌（IC）和未筛查发现（NSD）。我们通过诊断时的分期和 CF 对各组进行比较。报告了 CRC 死亡率的趋势。
结果
SD 病例中 I 期的比例为 51%，高于 PS（19%；OR 4.66，95%CI 3.50-6.20）、NSD（20.6%；OR 3.96，95%CI 2.95-5.32）和 IC（33.3%；OR 2.11，95%CI 1.10-4.04）。PS、NSD 和 SD 病例的 CF 分别为 57%（95%CI 54-60%）、60%（95%CI 58-63%）和 93%（95%CI 89-96%）。CRC 死亡率从 40.7 降至 25.6/100000。
结论
该计划显著改善了患者的预后，降低了 CRC 的死亡率和晚期 CRC 的发生率。
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