Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, VIC, Australia.
Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.
Br J Cancer. 2023 Oct;129(6):993-1006. doi: 10.1038/s41416-023-02377-w. Epub 2023 Aug 1.
This systematic review and meta-analysis aimed to evaluate existing evidence on the relationship between diagnostic and treatment intervals and outcomes for colorectal cancer.
Four databases were searched for English language articles assessing the role of time before initial treatment in colorectal cancer on any outcome, including stage and survival. Two reviewers independently screened articles for inclusion and data were synthesised narratively. A dose-response meta-analysis was performed to examine the association between treatment interval and survival.
One hundred and thirty papers were included in the systematic review, eight were included in the meta-analysis. Forty-five different intervals were considered in the time from first symptom to treatment. The most common finding was of no association between the length of intervals on any outcome. The dose-response meta-analysis showed a U-shaped association between the treatment interval and overall survival with the nadir at 45 days.
The review found inconsistent, but mostly a lack of, association between interval length and colorectal cancer outcomes, but study design and quality were heterogeneous. Meta-analysis suggests survival becomes increasingly poorer for those commencing treatment more than 45 days after diagnosis.
This review was registered, and the protocol is available, in PROSPERO, the international database of systematic reviews, with the registration ID CRD42021255864.
本系统评价和荟萃分析旨在评估结直肠癌诊断和治疗间隔与结局之间关系的现有证据。
在四个数据库中搜索评估初始治疗前时间对任何结局(包括分期和生存)的影响的英文文献。两名审查员独立筛选纳入的文献并进行叙述性综合。进行剂量-反应荟萃分析以检验治疗间隔与生存之间的关联。
系统评价纳入了 130 篇论文,8 篇论文纳入荟萃分析。45 个不同的时间段被考虑用于从首发症状到治疗的时间。最常见的发现是间隔长度与任何结局之间均无关联。剂量-反应荟萃分析显示,治疗间隔与总生存之间呈 U 形关联,最低点为 45 天。
该综述发现间隔长度与结直肠癌结局之间的关联不一致,但大多数情况下缺乏关联,但研究设计和质量存在异质性。荟萃分析表明,诊断后超过 45 天开始治疗的患者,其生存情况越来越差。
本综述已在国际系统评价数据库 PROSPERO 中注册,注册号为 CRD42021255864。