Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
Tayside Cancer Centre, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK.
Br J Surg. 2023 Mar 30;110(4):456-461. doi: 10.1093/bjs/znad003.
The national response to COVID-19 has had a significant impact on cancer services. This study investigated the effect of national lockdown on diagnosis, management, and outcomes of patients with oesophagogastric cancers in Scotland.
This retrospective cohort study included consecutive new patients presenting to regional oesophagogastric cancer multidisciplinary teams in National Health Service Scotland between October 2019 and September 2020. The study interval was divided into before and after lockdown, based on the first UK national lockdown. Electronic health records were reviewed and results compared.
Some 958 patients with biopsy-proven oesophagogastric cancer in 3 cancer networks were included: 506 (52.8 per cent) before and 452 (47.2 per cent) after lockdown. Median age was 72 (range 25-95) years and 630 patients (65.7 per cent) were men. There were 693 oesophageal (72.3 per cent) and 265 gastric (27.7 per cent) cancers. Median time to gastroscopy was 15 (range 0-337) days before versus 19 (0-261) days after lockdown (P < 0.001). Patients were more likely to present as an emergency after lockdown (8.5 per cent before versus 12.4 per cent after lockdown; P = 0.005), had poorer Eastern Cooperative Oncology group performance status, were more symptomatic, and presented with a higher stage of disease (stage IV: 49.8 per cent before versus 58.8 per cent after lockdown; P = 0.04). There was a shift to treatment with non-curative intent (64.6 per cent before versus 77.4 per cent after lockdown; P < 0.001). Median overall survival was 9.9 (95 per cent c.i. 8.7 to 11.4) months before and 6.9 (5.9 to 8.3) months after lockdown (HR 1.26, 95 per cent c.i. 1.09 to 1.46; P = 0.002).
This national study has highlighted the adverse impact of COVID-19 on oesophagogastric cancer outcomes in Scotland. Patients presented with more advanced disease and a shift towards treatment with non-curative intent was observed, with a subsequent negative impact on overall survival.
新冠疫情的全国应对措施对癌症服务产生了重大影响。本研究调查了英国首次全国封锁对苏格兰地区胃食管癌症多学科团队中患者的诊断、治疗和结局的影响。
本回顾性队列研究纳入了 2019 年 10 月至 2020 年 9 月期间在苏格兰国民保健服务中连续出现的新确诊的活检证实为胃食管癌症的区域胃食管癌症多学科团队的患者。研究间隔基于英国首次全国封锁分为封锁前和封锁后两个阶段。回顾电子健康记录并比较结果。
在 3 个癌症网络中，共有 958 例经活检证实的胃食管癌症患者入选：506 例（52.8%）在封锁前，452 例（47.2%）在封锁后。中位年龄为 72 岁（范围 25-95 岁），630 例患者（65.7%）为男性。693 例为食管癌（72.3%），265 例为胃癌（27.7%）。内窥镜检查的中位时间为封锁前 15 天（范围 0-337 天），封锁后为 19 天（0-261 天）（P<0.001）。封锁后更有可能以急症就诊（8.5%比封锁前 12.4%；P=0.005），ECOG 表现状态较差，症状更明显，疾病分期更高（IV 期：封锁前 49.8%，封锁后 58.8%；P=0.04）。非治愈性治疗的比例增加（64.6%比封锁前 77.4%；P<0.001）。封锁前中位总生存期为 9.9 个月（95%置信区间 8.7-11.4），封锁后为 6.9 个月（5.9-8.3）（HR 1.26，95%置信区间 1.09-1.46；P=0.002）。
这项全国性研究强调了 COVID-19 对苏格兰地区胃食管癌症结局的不利影响。患者的疾病表现更为晚期，并且观察到向非治愈性治疗的转变，这对总生存期产生了负面影响。
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