Academic Unit of Surgery, Department of Surgery, University of Glasgow, Level 2, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.
Sci Rep. 2022 Mar 14;12(1):4366. doi: 10.1038/s41598-022-08447-y.
Colorectal cancer remains a significant cause of morbidity and mortality, even despite curative treatment. A significant proportion of patients present emergently and have poorer outcomes compared to elective presentations, independent of TNM stage. In this systematic review and meta-analysis, differences between elective/emergency presentations of colorectal cancer were examined to determine which factors were associated with emergency presentation. A literature search was carried out from 1990 to 2018 comparing elective and emergency presentations of colon and/or rectal cancer. All reported clinicopathological variables were extracted from identified studies. Variables were analysed through either systematic review or, if appropriate, meta-analysis. This study identified multiple differences between elective and emergency presentations of colorectal cancer. On meta-analysis, emergency presentations were associated with more advanced tumour stage, both overall (OR 2.05) and T/N/M/ subclassification (OR 2.56/1.59/1.75), more: lymphovascular invasion (OR 1.76), vascular invasion (OR 1.92), perineural invasion (OR 1.89), and ASA (OR 1.83). Emergencies were more likely to be of ethnic minority (OR 1.58). There are multiple tumour/host factors that differ between elective and emergency presentations of colorectal cancer. Further work is required to determine which of these factors are independently associated with emergency presentation and subsequently which factors have the most significant effect on outcomes.
结直肠癌仍然是发病率和死亡率的重要原因，即使经过治愈性治疗也是如此。与择期就诊相比，相当一部分患者表现为紧急情况，且预后较差，与 TNM 分期无关。在这项系统评价和荟萃分析中，比较了结直肠癌的择期/紧急就诊之间的差异，以确定哪些因素与紧急就诊相关。从 1990 年到 2018 年，进行了一项比较结肠癌和/或直肠癌择期和紧急就诊的文献检索。从确定的研究中提取了所有报告的临床病理变量。通过系统评价或适当的荟萃分析对变量进行分析。本研究确定了结直肠癌择期和紧急就诊之间存在多种差异。荟萃分析显示，紧急就诊与更晚期的肿瘤分期相关，包括总体分期（OR 2.05）和 T/N/M 亚分类（OR 2.56/1.59/1.75），更多的：淋巴血管侵犯（OR 1.76）、血管侵犯（OR 1.92）、神经周围侵犯（OR 1.89）和 ASA（OR 1.83）。紧急情况更有可能是少数民族（OR 1.58）。结直肠癌的择期和紧急就诊之间存在多种肿瘤/宿主因素。需要进一步研究确定这些因素中哪些与紧急就诊独立相关，以及哪些因素对结果有最显著的影响。
