Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Ourense 32005, Orense, Spain.
Department of Preventive Medicine, Complexo Hospitalario Universitario de Ourense, Ourense 32003, Orense, Spain.
World J Gastroenterol. 2021 Oct 21;27(39):6689-6700. doi: 10.3748/wjg.v27.i39.6689.
The implementation of a colorectal cancer (CRC) screening programme may increase the awareness of Primary Care Physicians, reduce the diagnostic delay in CRC detected outside the scope of the screening programme and thus improve prognosis.
To determine the effect of implementation of a CRC screening programme on diagnostic delays and prognosis of CRC detected outside the scope of a screening programme.
We performed a retrospective intervention study with a pre-post design. We identified 322 patients with incident and confirmed CRC in the pre-implantation cohort (June 2014 - May 2015) and 285 in the post-implantation cohort (June 2017 - May 2018) in the Cancer Registry detected outside the scope of a CRC screening programme. In each patient we calculated the different healthcare diagnostics delays: global, primary and secondary healthcare, referral and colonoscopy-related delays. In addition, we collected the initial healthcare that evaluated the patient, the home location (urban/rural), and the CRC stage at diagnosis. We determined the two-year survival and we performed a multivariate proportional hazard regression analysis to determine the variables associated with survival.
We did not detect any differences in the patient or CRC baseline-related variables. A total of 20.1% of patients was detected with metastatic disease. There was a significant increase in direct referral to colonoscopy from primary healthcare (25.5%, 35.8%; = 0.04) in the post-implantation cohort. Diagnostic delay was reduced by 24 d (106.64 ± 148.84 days, 82.84 ± 109.31 d; = 0.02) due to the reduction in secondary healthcare delay (46.01 ± 111.65 d; 29.20 ± 60.83 d; = 0.02). However, we did not find any differences in CRC stage at diagnosis or in two-year survival (70.3%; = 0.9). Variables independently associated with two-year risk of death were age (Hazard Ratio-HR: 1.06, 95%CI: 1.04-1.07), CRC stage (II HR: 2.17, 95%CI: 1.07-4.40; III HR: 3.07, 95%CI: 1.56-6.08; IV HR: 19.22, 95%CI: 9.86-37.44; unknown HR: 9.24, 95%CI: 4.27-19.99), initial healthcare consultation (secondary HR: 2.93, 95%CI: 1.01-8.55; emergency department HR: 2.06, 95%CI: 0.67-6.34), hospitalization during the diagnostic process (HR: 1.67, 95%CI: 1.17-2.38) and urban residence (HR: 1.44, 95%CI: 1.06-1.98).
Although implementation of a CRC screening programme can reduce diagnostic delays for CRC detected in symptomatic patients, this has no effect on CRC stage or survival.
结直肠癌（CRC）筛查计划的实施可以提高初级保健医生的认识，减少筛查范围外发现的 CRC 的诊断延迟，从而改善预后。
确定 CRC 筛查计划的实施对筛查范围外发现的 CRC 的诊断延迟和预后的影响。
我们进行了一项回顾性干预研究，采用前后设计。我们在癌症登记处确定了 322 名在植入前队列（2014 年 6 月至 2015 年 5 月）和 285 名在植入后队列（2017 年 6 月至 2018 年 5 月）中发现的患有 CRC 的患者，这些患者的 CRC 不在筛查范围内。在每个患者中，我们计算了不同的医疗保健诊断延迟：整体、初级和二级医疗保健、转诊和结肠镜检查相关的延迟。此外，我们收集了评估患者的初始医疗保健、家庭住址（城市/农村）和诊断时的 CRC 分期。我们确定了两年的生存率，并进行了多变量比例风险回归分析，以确定与生存相关的变量。
我们没有发现患者或 CRC 基线相关变量的差异。共有 20.1%的患者被发现患有转移性疾病。在植入后队列中，直接转诊至结肠镜检查的比例从初级保健增加了 25.5%（35.8%； = 0.04）。由于二级保健延迟减少了 46.01 ± 111.65 天（29.20 ± 60.83 天； = 0.02），诊断延迟减少了 24 天（106.64 ± 148.84 天；82.84 ± 109.31 天； = 0.02）。然而，我们没有发现 CRC 分期或两年生存率的差异（70.3%； = 0.9）。与两年死亡风险相关的独立变量包括年龄（风险比[HR]：1.06，95%置信区间：1.04-1.07）、CRC 分期（II 期 HR：2.17，95%置信区间：1.07-4.40；III 期 HR：3.07，95%置信区间：1.56-6.08；IV 期 HR：19.22，95%置信区间：9.86-37.44；未知 HR：9.24，95%置信区间：4.27-19.99）、初始医疗保健咨询（二级 HR：2.93，95%置信区间：1.01-8.55；急诊 HR：2.06，95%置信区间：0.67-6.34）、诊断过程中的住院治疗（HR：1.67，95%置信区间：1.17-2.38）和城市居住（HR：1.44，95%置信区间：1.06-1.98）。
尽管 CRC 筛查计划的实施可以减少筛查范围外发现的 CRC 的诊断延迟，但这对 CRC 分期或生存率没有影响。
