结直肠癌快速通道：癌症检出率及入选标准的预测价值。

Colorectal Cancer Fast Tracks: Cancer Yield and the Predictive Value of Entry Criteria.

作者信息

Uebel Linnea, Kromodikoro Indy, Nyhlin Nils, van Nieuwenhoven Michiel

机构信息

Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Region Örebro County, SE 70116 Örebro, Sweden.

Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, SE 70182 Örebro, Sweden.

出版信息

Cancers (Basel). 2023 Sep 28;15(19):4778. doi: 10.3390/cancers15194778.

DOI:10.3390/cancers15194778

PMID:37835472

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10571709/

Abstract

BACKGROUND

Fast-track pathways for diagnosing colorectal cancer (CRC) have been implemented in several European countries. In Sweden, a substantial number of CRC are diagnosed via the Swedish Standardized Course of Care for colorectal cancer (SCC-CRC). We evaluated the SCC-CRC in terms of CRC yield, and predictive values and odds ratios (OR) for the entry criteria.

METHODS

We retrospectively analyzed all 2539 patients referred for SCC-CRC colonoscopy between September 2016 and December 2020. Entry criteria and colonoscopy outcomes were analyzed.

RESULTS

CRC yield was 16.4%. Highest positive predictive values (PPVs) were seen for abnormal radiology (PPV 30.5%, OR 4.7 (95% CI 3.4-6.4) < 0.001), abnormal rectal examination (PPV 28%, OR 3.6 (95% CI 2.7-4.8) < 0.001), and anemia (PPV 24.8%, OR 2.2 (95% CI 1.5-3.1) < 0.001). Some entry criteria showed no significant risk increase, i.e., visible blood in stool/rectal bleeding, change in bowel habits, and the combination of changed bowel habits plus anemia. A positive fecal immunochemical test (FIT), although not part of the SCC-CRC, showed the highest OR: 9.9 (95% CI 4.5-21.7) < 0.001) and PPV of 18.8%.

CONCLUSIONS

CRC yield from the SCC-CRC is slightly higher compared to other European fast tracks. A number of entry criteria showed no benefit towards assessing CRC risk. FIT testing should be included in CRC fast tracks to increase diagnostic efficacy.

摘要

背景

多个欧洲国家已实施了结直肠癌（CRC）的快速诊断途径。在瑞典，相当数量的CRC是通过瑞典结直肠癌标准化护理流程（SCC-CRC）诊断出来的。我们从CRC检出率、入选标准的预测值和比值比（OR）方面对SCC-CRC进行了评估。

方法

我们回顾性分析了2016年9月至2020年12月期间因SCC-CRC结肠镜检查而转诊的所有2539例患者。分析了入选标准和结肠镜检查结果。

结果

CRC检出率为16.4%。放射学异常的阳性预测值（PPV）最高（PPV为30.5%，OR为4.7（95%CI 3.4 - 6.4）<0.001），直肠指检异常（PPV为28%，OR为3.6（95%CI 2.7 - 4.8）<0.001），以及贫血（PPV为24.8%，OR为2.2（95%CI 1.5 - 3.1）<0.001）。一些入选标准未显示出显著的风险增加，即粪便中可见血液/直肠出血、排便习惯改变以及排便习惯改变加贫血的组合。粪便免疫化学试验（FIT）呈阳性，尽管它不是SCC-CRC的一部分，但其OR最高：9.9（95%CI 4.5 - 21.7）<0.001），PPV为18.8%。