2019年冠状病毒病大流行对基于人群的有组织筛查计划中结直肠癌诊断的影响

Impact of the COVID-19 Pandemic on the Diagnosis of Colorectal Cancer within a Population-Based Organized Screening Program.

作者信息

Cubiella Joaquín, Calderón-Cruz Beatriz, Almazán Raquel, Gómez-Amorín Ángel

机构信息

Servicio de Aparato Digestivo, Hospital Universitario de Ourense, Grupo de Investigación en Oncología Digestiva-Ourense, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, 32003 Ourense, Spain.

Unidad de Metodología y Estadística, Instituto de Investigación Sanitaria Galicia Sur, 36312 Vigo, Spain.

出版信息

Cancers (Basel). 2023 Oct 4;15(19):4853. doi: 10.3390/cancers15194853.

DOI:10.3390/cancers15194853

PMID:37835547

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10571915/

Abstract

BACKGROUND

The interruption of the activity of population-based organized colorectal cancer (CRC) screening programs due to the COVID pandemic may have affected their results in terms of the detection of preneoplastic lesions and CRC. We evaluated the impact of the COVID pandemic on the delays, participation, adherence to colonoscopies, lesions detected, and CRC stage at diagnosis in a CRC screening program.

METHODS

We analyzed all the invitations between 1 January 2019 and 31 December 2021. We defined the pandemic period as the period after 12 March 2020. We calculated the delay intervals (successive and all rounds), the rates of participation, adherence to colonoscopy after a positive fecal immunochemical test (FIT), and the diagnostic yield of colonoscopy, specifically of CRC and colorectal neoplasia (CRC and/or adenoma), as well as the CRC stage at diagnosis.

RESULTS

In the period analyzed, 976,187 invitations were sent (61.0% in the pandemic period), 439,687 FIT were returned (62.4% in the pandemic period) and 23,092 colonoscopies were performed (59.1% in the pandemic period). The colonoscopies were normal in 7378 subjects (32.4%) and CRC was detected in 916 subjects (4.0%). In successive rounds, the delay increased significantly by seven months during the pandemic period ( < 0.001). In all the invitations, the delay from the invitation to the colonoscopy increased significantly by 8 days ( < 0.001). Once adjusted for the confounding variables, the participation in the screening program increased significantly (OR = 1.1; 95% CI = 1.09-1.11), with no changes in the adherence to colonoscopy (OR = 0.9; 95% CI = 0.8-1.0). We found no differences in the diagnostic yield of colonoscopy in terms of CRC (OR = 0.90; 95% CI = 0.78-1.02) or colorectal neoplasia (OR = 0.98; 95% CI = 0.92-1.03) detection. Finally, we found no differences in the CRC stage at diagnosis ( = 0.2).

CONCLUSIONS

Although the interruption of the CRC screening program due to the COVID pandemic increased the delays, it did not reduce participation, adherence to colonoscopy, or the diagnostic yield of colonoscopy.

摘要

背景

由于新冠疫情，基于人群的有组织的结直肠癌（CRC）筛查项目活动中断，这可能在癌前病变和CRC的检测方面影响了其结果。我们评估了新冠疫情对CRC筛查项目中延迟情况、参与度、结肠镜检查依从性、检测到的病变以及诊断时CRC分期的影响。

方法

我们分析了2019年1月1日至2021年12月31日期间所有的邀请。我们将疫情期间定义为2020年3月12日之后的时期。我们计算了延迟间隔（连续轮次和所有轮次）、参与率、粪便免疫化学检测（FIT）呈阳性后结肠镜检查的依从性、结肠镜检查的诊断率，特别是CRC和结直肠肿瘤（CRC和/或腺瘤）的诊断率，以及诊断时的CRC分期。

结果

在分析的时间段内，共发出976,187份邀请（疫情期间占61.0%），返回439,687份FIT（疫情期间占62.4%），进行了23,092例结肠镜检查（疫情期间占59.1%）。7378名受试者的结肠镜检查结果正常（32.4%），916名受试者检测到CRC（4.0%）。在连续轮次中，疫情期间延迟显著增加了7个月（<0.001）。在所有邀请中，从邀请到结肠镜检查的延迟显著增加了8天（<0.001）。在对混杂变量进行调整后筛查项目的参与度显著增加（OR = 1.1；95%CI = 1.09 - 1.11），而结肠镜检查的依从性没有变化（OR = 0.9；95%CI = 0.8 - 1.0）。在CRC（OR = 0.90；95%CI = 0.78 - 1.02）或结直肠肿瘤（OR = 0.98；95%CI = 0.92 - 1.03）检测方面，我们发现结肠镜检查的诊断率没有差异。最后，我们发现诊断时的CRC分期没有差异（= 0.2）。