Department of Surgery, East Carolina University Brody School of Medicine, Greenville, NC, United States of America.
East Carolina University Brody School of Medicine, Greenville, NC, United States of America.
PLoS One. 2023 Sep 14;18(9):e0291447. doi: 10.1371/journal.pone.0291447. eCollection 2023.
Nearly 23 million adults ages 50-75 are overdue for colorectal cancer (CRC) screening. In March 2020, the Centers for Medicare & Medicaid issued guidance that all non-urgent procedures be delayed due to the COVID-19 pandemic. Screening delays may have effects on the presentation of rectal cancer and the natural history of the disease. The aim of this study was to determine if procedural suspension due to the COVID-19 pandemic was associated with an increased proportion of acute presentations or more advanced stage at diagnosis for patients with rectal cancer. We conducted a single-center, retrospective review of adult patients with new or recurrent rectal adenocarcinoma from 2016-2021. We compared patients presenting before (pre-COVID) to those diagnosed after (COVID) March 1, 2020. Of 208 patients diagnosed with rectal cancer, 163 were diagnosed pre-COVID and 45 patients in the COVID group. Cohorts did not differ among age, sex, race, insurance status, marital status, rurality, or BMI. There was no difference in stage at presentation with the majority diagnosed with stage III disease (40.0% vs 33.3%, p = 0.26). Similar proportions of patients presented acutely (67.5% vs 64.4%, p = 0.71). Presenting symptoms were also similar between cohorts. On adjusted analysis, male sex, white race, and uninsured status were found to have significant impact acuity of presentation, while diagnosis before or after the onset of the pandemic remained non-significant (OR 1.25, 95% CI0.57-2.72; p = 0.59). While screening rates have decreased during the COVID pandemic, patients with rectal cancer did not appear to have an increased level of acuity or stage at presentation. These findings could result from the indolent nature of the disease and may change as the pandemic progresses.
近 2300 万 50-75 岁的成年人未进行结肠癌（CRC）筛查。2020 年 3 月，医疗保险和医疗补助中心发布指导意见，由于 COVID-19 大流行，所有非紧急程序均被推迟。筛查延迟可能会对直肠癌的表现和疾病的自然史产生影响。本研究旨在确定 COVID-19 大流行期间由于程序暂停是否与直肠癌患者急性表现的比例增加或诊断时更晚期有关。我们对 2016-2021 年期间患有新发或复发性直肠腺癌的成年患者进行了单中心回顾性研究。我们比较了 2016 年 3 月 1 日之前（COVID 之前）就诊的患者与之后（COVID 之后）诊断的患者。在 208 例诊断为直肠癌的患者中，163 例诊断为 COVID 之前，45 例诊断为 COVID 之后。两组在年龄、性别、种族、保险状况、婚姻状况、农村地区或 BMI 方面没有差异。在发病时的分期没有差异，大多数患者被诊断为 III 期疾病（40.0% vs 33.3%，p = 0.26）。急性表现的患者比例相似（67.5% vs 64.4%，p = 0.71）。两组的首发症状也相似。在调整分析中，男性、白人种族和无保险状态被发现对发病的严重程度有显著影响，而在大流行前后的诊断仍然没有显著影响（OR 1.25，95%CI0.57-2.72；p = 0.59）。虽然 COVID 大流行期间筛查率有所下降，但直肠癌患者的发病严重程度似乎并未增加。这些发现可能是由于疾病的惰性特征所致，随着大流行的进展，情况可能会发生变化。
