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比较年轻和老年结直肠癌患者的诊断和治疗时间:一项基于人群的研究。

Comparing Time to Diagnosis and Treatment Between Younger and Older Adults With Colorectal Cancer: A Population-Based Study.

机构信息

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.

出版信息

Gastroenterology. 2023 Jun;164(7):1152-1164. doi: 10.1053/j.gastro.2023.02.024. Epub 2023 Feb 24.


DOI:10.1053/j.gastro.2023.02.024
PMID:
Abstract

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.

摘要

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。

相似文献

[1]
Comparing Time to Diagnosis and Treatment Between Younger and Older Adults With Colorectal Cancer: A Population-Based Study.

Gastroenterology. 2023-6

[2]
Analysis of Time to Treatment and Survival Among Adults Younger Than 50 Years of Age With Colorectal Cancer in Canada.

JAMA Netw Open. 2023-8-1

[3]
Measurement of clinical delay intervals among younger adults with colorectal cancer using health administrative data: a population-based analysis.

BMJ Open Gastroenterol. 2022-11

[4]
Advanced-Stage Colorectal Cancer in Persons Younger Than 50 Years Not Associated With Longer Duration of Symptoms or Time to Diagnosis.

Clin Gastroenterol Hepatol. 2017-5

[5]
Clinical Delays and Comparative Outcomes in Younger and Older Adults with Colorectal Cancer: A Systematic Review.

Curr Oncol. 2022-11-12

[6]
Aspects of survival from colorectal cancer in Denmark.

Dan Med J. 2012-4

[7]
Time to diagnosis and treatment in younger adults with colorectal cancer: A systematic review.

PLoS One. 2022

[8]
Patterns of colorectal cancer diagnosis among younger adults in a real-world, population-based cohort.

Future Oncol. 2022-1

[9]
Patient-reported diagnostic intervals to colorectal cancer diagnosis in the Midland region of New Zealand: a prospective cohort study.

Fam Pract. 2022-7-19

[10]
Rural-Urban Disparities in Time to Diagnosis and Treatment for Colorectal and Breast Cancer.

Cancer Epidemiol Biomarkers Prev. 2018-7-9

引用本文的文献

[1]
Early-onset colorectal cancer in patients younger than 50 years: a systematic review of the literature.

Ann Gastroenterol. 2025

[2]
Time to Treatment Initiation of Lung, Breast, Colorectal, and Prostate Cancers and Contributing Factors From 2015 to 2020 Utilizing Surveillance, Epidemiology, and End Results Program Database.

World J Oncol. 2025-4

[3]
Determining factors of presentation and diagnosis delays in patients with colorectal cancer and the impact on stage: a cross sectional study in Yogyakarta, Indonesia.

Ecancermedicalscience. 2024-9-11

[4]
Improving Care for Older Adults with Cancer in Canada: A Call to Action.

Curr Oncol. 2024-6-30

[5]
Red Flag Signs and Symptoms for Patients With Early-Onset Colorectal Cancer: A Systematic Review and Meta-Analysis.

JAMA Netw Open. 2024-5-1

[6]
Analysis of Time to Treatment and Survival Among Adults Younger Than 50 Years of Age With Colorectal Cancer in Canada.

JAMA Netw Open. 2023-8-1

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