Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Kanazawa-ku, Yokohama, Japan.
National Hospital Organization Yokohama Medical Center, Totuka-ku, Yokohama, Japan.
JAMA Netw Open. 2021 Sep 1;4(9):e2126334. doi: 10.1001/jamanetworkopen.2021.26334.
The COVID-19 pandemic has delayed medical consultations, possibly leading to the diagnosis of gastrointestinal cancer at advanced stages.
To evaluate stage at diagnosis among patients with gastrointestinal cancer in Japan before and during the COVID-19 pandemic.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included patients in a hospital-based cancer registry who were diagnosed with gastrointestinal cancer (ie, esophageal, gastric, colorectal, pancreatic, liver, and biliary tract cancers) between January 2016 and December 2020 at 2 tertiary Japanese hospitals.
The pre-COVID-19 period was defined as January 2017 to February 2020, and the COVID-19 period was defined as March 2020 to December 2020.
Monthly numbers of patients with newly diagnosed cancer were aggregated, classified by stage, and compared.
The study evaluated 5167 patients, including 4218 patients (2825 [67.0%] men; mean [SD] age, 71.3 [10.9] years) in the pre-COVID-19 period and 949 patients (607 [64.0%] men; mean [SD] age, 71.8 [10.7] years) in the COVID-19 period. Comparing the pre-COVID-19 period with the COVID-19 period, significant decreases were observed in the mean (SD) number of patients with newly diagnosed gastric cancer (30.63 [6.62] patients/month vs 22.40 [5.85] patients/month; -26.87% change; P < .001) and colorectal cancer (41.61 [6.81] patients/month vs 36.00 [6.72] patients/month; -13.47% change; P = .03). Significant decreases were also observed in the mean (SD) number of cases of stage I gastric cancer (21.55 [5.66] cases/month vs 13.90 [5.99] cases/month; -35.51% change; P < .001), stage 0 colorectal cancer (10.58 [3.36] cases/month vs 7.10 [4.10] cases/month; -32.89% change; P = .008), and stage I colorectal cancer (10.16 [3.14] cases/month vs 6.70 [2.91] cases/month; -34.04% change; P = .003). No significant increases were observed for esophageal, gastric, pancreatic, liver, or biliary tract cancers. A significant decrease was observed in the mean (SD) number of cases per month of stage II colorectal cancer (7.42 [3.06] cases/month vs 4.80 [1.75] cases/month; -35.32% change; P = .01); a significant increase was observed for the mean (SD) number of cases per month of stage III colorectal cancer (7.18 [2.85] cases/month vs 12.10 [2.42] cases/month; 68.42% change; P < .001).
In this cohort study of patients in a hospital-based cancer registry form Japan, significantly fewer patients were diagnosed with stage I gastric and colorectal cancers during the COVID-19 pandemic. Thus, the number of screening-detected cancers might have decreased, and colorectal cancer may have been diagnosed at more advanced stages.
COVID-19 大流行导致医疗咨询延迟，可能导致胃肠道癌的诊断处于晚期。
评估日本胃肠道癌患者在 COVID-19 大流行前后的诊断阶段。
设计、地点和参与者：本回顾性队列研究纳入了在 2 家日本三级医院基于医院的癌症登记处诊断为胃肠道癌（即食管、胃、结直肠、胰腺、肝和胆道癌）的患者，纳入时间为 2016 年 1 月至 2020 年 12 月。
COVID-19 大流行前阶段定义为 2017 年 1 月至 2020 年 2 月，COVID-19 大流行期间定义为 2020 年 3 月至 12 月。
汇总新诊断癌症患者的每月数量，按阶段分类并进行比较。
本研究共评估了 5167 名患者，包括在 COVID-19 大流行前阶段的 4218 名患者（2825 名[67.0%]男性；平均[SD]年龄 71.3[10.9]岁）和 COVID-19 大流行期间的 949 名患者（607 名[64.0%]男性；平均[SD]年龄 71.8[10.7]岁）。与 COVID-19 大流行前阶段相比，COVID-19 大流行期间新诊断胃癌（30.63[6.62]例/月 vs 22.40[5.85]例/月；变化率-26.87%；P < .001）和结直肠癌（41.61[6.81]例/月 vs 36.00[6.72]例/月；变化率-13.47%；P = .03）的平均（SD）新诊断患者数量均显著减少。Ⅰ期胃癌（21.55[5.66]例/月 vs 13.90[5.99]例/月；变化率-35.51%；P < .001）和 0 期结直肠癌（10.58[3.36]例/月 vs 7.10[4.10]例/月；变化率-32.89%；P = .008）和Ⅰ期结直肠癌（10.16[3.14]例/月 vs 6.70[2.91]例/月；变化率-34.04%；P = .003）的平均（SD）每月病例数也显著减少。食管、胃、胰腺、肝或胆道癌未见明显增加。Ⅱ期结直肠癌（7.42[3.06]例/月 vs 4.80[1.75]例/月；变化率-35.32%；P = .01）的平均（SD）每月病例数减少，而Ⅲ期结直肠癌（7.18[2.85]例/月 vs 12.10[2.42]例/月；变化率 68.42%；P < .001）的平均（SD）每月病例数增加。
在这项来自日本基于医院的癌症登记处的患者队列研究中，COVID-19 大流行期间，Ⅰ期胃癌和结直肠癌的诊断数量明显减少。因此，筛查发现的癌症数量可能减少，结直肠癌可能被诊断为更晚期。
