Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
PLoS One. 2022 Sep 12;17(9):e0273396. doi: 10.1371/journal.pone.0273396. eCollection 2022.
The incidence of colorectal cancer is rising in adults <50 years of age. As a primarily unscreened population, they may have clinically important delays to diagnosis and treatment. This study aimed to review the literature on delay intervals in patients <50 years with colorectal cancer (CRC), and explore associations between longer intervals and outcomes.
MEDLINE, Embase, and LILACS were searched until December 2, 2021. We included studies published after 1990 reporting any delay interval in adults <50 with CRC. Interval measures and associations with stage at presentation or survival were synthesized and described in a narrative fashion. Risk of bias was assessed using the Newcastle-Ottawa Scale, Institute of Health Economics Case Series Quality Appraisal Checklist, and the Aarhus Checklist for cancer delay studies.
55 studies representing 188,530 younger CRC patients were included. Most studies used primary data collection (64%), and 47% reported a single center. Sixteen unique intervals were measured. The most common interval was symptom onset to diagnosis (21 studies; N = 2,107). By sample size, diagnosis to treatment start was the most reported interval (12 studies; N = 170,463). Four studies examined symptoms onset to treatment start (total interval). The shortest was a mean of 99.5 days and the longest was a median of 217 days. There was substantial heterogeneity in the measurement of intervals, and quality of reporting. Higher-quality studies were more likely to use cancer registries, and be population-based. In four studies reporting the relationship between intervals and cancer stage or survival, there were no clear associations between longer intervals and adverse outcomes.
Adults <50 with CRC may have intervals between symptom onset to treatment start greater than 6 months. Studies reporting intervals among younger patients are limited by inconsistent results and heterogeneous reporting. There is insufficient evidence to determine if longer intervals are associated with advanced stage or worse survival.
This study's protocol was registered with the Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42020179707).
50 岁以下成年人的结直肠癌发病率正在上升。由于他们主要未接受筛查，因此可能在诊断和治疗方面存在临床重要的延迟。本研究旨在回顾 50 岁以下结直肠癌（CRC）患者的延迟间隔时间相关文献，并探讨较长间隔时间与结局之间的关系。
截至 2021 年 12 月 2 日，我们检索了 MEDLINE、Embase 和 LILACS 数据库，纳入了 1990 年后发表的报告 50 岁以下成年人 CRC 患者任何延迟间隔时间的研究。以叙述的方式综合和描述间隔时间测量值以及与就诊时分期或生存的关系。使用纽卡斯尔-渥太华量表、卫生经济学研究所病例系列质量评估清单和奥胡斯癌症延迟研究清单评估偏倚风险。
共纳入了 55 项研究，代表了 188530 名年轻 CRC 患者。大多数研究采用了原始数据收集（64%），47%的研究报告为单中心研究。共测量了 16 个独特的间隔时间。最常见的间隔时间是症状出现到诊断（21 项研究；N=2107）。按样本量计算，诊断到治疗开始的间隔时间是报告最多的间隔时间（12 项研究；N=170463）。有 4 项研究检查了症状出现到治疗开始的总间隔时间。最短为平均 99.5 天，最长为中位数 217 天。间隔时间的测量存在很大的异质性，报告质量也参差不齐。质量较高的研究更有可能使用癌症登记处，并且为基于人群的研究。在 4 项报告间隔时间与癌症分期或生存关系的研究中，较长的间隔时间与不良结局之间没有明确的关联。
50 岁以下的 CRC 患者从症状出现到治疗开始的间隔时间可能超过 6 个月。报告年轻患者间隔时间的研究受到结果不一致和报告异质性的限制。目前尚无足够的证据来确定较长的间隔时间是否与晚期疾病或较差的生存相关。
本研究方案已在系统评价前瞻性登记处（PROSPERO；注册编号 CRD42020179707）注册。
