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; ICES, Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada.
Gastroenterology. 2023 Jun;164(7):1152-1164. doi: 10.1053/j.gastro.2023.02.024. Epub 2023 Feb 24.
BACKGROUND & AIMS: Younger adults (aged <50 years) with colorectal cancer (CRC) may have prolonged delays to diagnosis and treatment that are associated with adverse outcomes. We compared delay intervals by age for patients with CRC in a large population. METHODS: This was a population-based study of adults diagnosed with CRC in Ontario, Canada, from 2003 to 2018. We measured the time between presentation and diagnosis (diagnostic interval), diagnosis and treatment start (treatment interval), and the time from presentation to treatment (overall interval). We compared interval lengths between adults aged <50 years, 50 to 74 years, and 75 to 89 years using multivariable quantile regression. RESULTS: Included were 90,225 patients with CRC. Of these, 6853 patients (7.6%) were aged <50 years. Younger patients were more likely to be women, present emergently, have stage IV disease, and have rectal cancer compared with middle-aged patients. Factors associated with significantly longer overall intervals included female sex (8.7 days; 95% confidence interval [CI], 6.6-10.9 days) and rectal cancer compared with proximal colon cancer (9.8 days; 95% CI, 7.4-2.2 days). After adjustment, adults aged <50 years had significantly longer diagnostic intervals (4.3 days; 95% CI. 1.3-7.3 days) and significantly shorter treatment intervals (-4.5 days; 95% CI, -5.3 to -3.7 days) compared with middle-aged patients. However, there was no significant difference in the overall interval (-0.6 days; 95% CI, -4.3 to 3.2 days). In stratified models, younger adults with stage IV disease who presented emergently and patients aged >75 years had longer overall intervals. CONCLUSIONS: Younger adults present more often with stage IV CRC but have overall similar times from presentation to treatment as screening-eligible older adults.
背景与目的:患有结直肠癌(CRC)的年轻人(年龄<50 岁)可能存在诊断和治疗的延迟,这与不良结局有关。我们比较了在一个大人群中 CRC 患者的年龄相关的延迟间隔。
方法:这是一项基于人群的研究,研究对象为 2003 年至 2018 年期间在加拿大安大略省被诊断患有 CRC 的成年人。我们测量了从就诊到诊断(诊断间隔)、诊断到治疗开始(治疗间隔)以及从就诊到治疗(总间隔)的时间。我们使用多变量分位数回归比较了年龄<50 岁、50-74 岁和 75-89 岁的成年人之间的间隔长度。
结果:共纳入 90225 例 CRC 患者。其中,6853 例(7.6%)年龄<50 岁。与中年患者相比,年轻患者更可能为女性、紧急就诊、患有 IV 期疾病和直肠癌。与近端结肠癌相比,总间隔显著延长的因素包括女性(8.7 天;95%置信区间[CI]:6.6-10.9 天)和直肠癌(9.8 天;95%CI:7.4-2.2 天)。调整后,与中年患者相比,年龄<50 岁的成年人的诊断间隔显著延长(4.3 天;95%CI:1.3-7.3 天),治疗间隔显著缩短(-4.5 天;95%CI:-5.3 至-3.7 天)。然而,总间隔无显著差异(-0.6 天;95%CI:-4.3 至 3.2 天)。在分层模型中,紧急就诊且患有 IV 期疾病的年轻成年人和年龄>75 岁的患者总间隔较长。
结论:年轻成年人更常出现 IV 期 CRC,但从就诊到治疗的总时间与符合筛查条件的老年成年人相似。
Clin Gastroenterol Hepatol. 2017-5
Dan Med J. 2012-4
Cancer Epidemiol Biomarkers Prev. 2018-7-9
Curr Oncol. 2024-6-30