Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
JAMA Netw Open. 2022 Nov 1;5(11):e2243119. doi: 10.1001/jamanetworkopen.2022.43119.
Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis.
To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery.
Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections.
The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable.
A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95% CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95% CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95% CI, 1.01-1.31; P = .03).
This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients.
由于 SARS-CoV-2 的爆发，筛查计划的延迟以及患者不愿就医，可能与结直肠癌诊断时更晚期的肿瘤有关。
评估 SARS-CoV-2 大流行是否与结直肠癌患者的肿瘤更晚期以及临床表现的变化有关。
设计、地点和参与者：这是一项回顾性、多中心队列研究，纳入了 2020 年 3 月 1 日至 2021 年 12 月 31 日（大流行期间）和 2018 年 1 月 1 日至 2020 年 2 月 29 日（大流行前期间）期间在意大利 81 个参与中心（包括三级中心和社区医院）接受结直肠癌手术的 17938 名成年患者。随访时间为手术后 30 天。
结直肠癌的任何类型手术，包括探查性手术、姑息性手术和非典型或节段性切除术。
主要结局是结直肠癌诊断时的晚期肿瘤。次要结局是远处转移、T4 期、侵袭性生物学（定义为具有以下至少 1 种特征的癌症：印戒细胞、黏液性肿瘤、芽生、血管淋巴管浸润、神经周围浸润和淋巴管炎）、狭窄病变、急诊手术和姑息性手术。使用多变量随机效应逻辑回归评估大流行期间与结局的独立关联，以医院为聚类变量。
共有 17938 名患者（10007 名男性[55.8%]；平均[标准差]年龄 70.6[12.2]岁）接受了结直肠癌手术：7796 名（43.5%）在大流行期间，10142 名（56.5%）在大流行前期间。逻辑回归表明，大流行期间与晚期结直肠癌的发生率增加显著相关（优势比[OR]，1.07；95%CI，1.01-1.13；P=0.03）、侵袭性生物学（OR，1.32；95%CI，1.15-1.53；P<0.001）和狭窄病变（OR，1.15；95%CI，1.01-1.31；P=0.03）。
这项队列研究表明，SARS-CoV-2 大流行与接受结直肠癌手术的患者的肿瘤更晚期诊断风险之间存在显著关联，这可能表明这些患者的生存机会降低。
