Epidemiological Department, Azienda Zero, Padova, Italy.
Epidemiological Department, Azienda Zero, Padova, Italy
BMJ Open Gastroenterol. 2024 Aug 5;11(1):e001434. doi: 10.1136/bmjgast-2024-001434.
Faecal immunochemical test (FIT)-based screening is effective in reducing colorectal cancer (CRC) incidence, but its sensitivity for proximal lesions remains low.
We compared age-adjusted CRC surgical resection rates across anatomic sites (proximal colon, distal colon, rectum), age groups and sex over 20 years in a large Italian population. We particularly focused on changes in trends following FIT-screening implementation in the target population (50-69 years).
This retrospective study analysed data from the Veneto Region's administrative Hospital Discharge Dataset, involving over 54 000 patients aged 40-89 (43.4% female) who underwent CRC surgery between 2002 and 2021.
Overall, surgery rates increased until 2007 (annual percentage changes: 2.5% in males, 2.9% in females) and then declined (-4.2% in males, -3.4% in females). This decline was steeper for distal and rectal cancers compared with proximal cancer, suggesting a shift towards more right-sided CRC surgery.In males, the prescreening increase in proximal surgery was reversed after screening implementation (slope change: -6%) while the prescreening decline accelerated for distal (-4%) and rectal (-3%) surgeries. In females, stable prescreening trends shifted downward for all sites (-5% for proximal, -8% for distal and -7% for rectal surgery). However, the change in trends between prescreening and postscreening periods was not different across anatomic sites for either sex (all slope change differences in pairwise comparisons were not statistically significant).
The shift towards proximal surgery may not be entirely due to the FIT's low sensitivity but may reflect an underlying upward trend in proximal cancers independent of screening.
基于粪便免疫化学检测（FIT）的筛查可有效降低结直肠癌（CRC）的发病率，但对近端病变的敏感性仍然较低。
我们比较了意大利一个大人群中 20 多年来不同解剖部位（近端结肠、远端结肠、直肠）、年龄组和性别中经年龄校正的 CRC 手术切除率。我们特别关注在目标人群（50-69 岁）中实施 FIT 筛查后趋势的变化。
本回顾性研究分析了威尼托地区行政医院出院数据集的数据，涉及 54000 多名年龄在 40-89 岁之间（43.4%为女性）的患者，他们在 2002 年至 2021 年间接受了 CRC 手术。
总体而言，手术率在 2007 年之前呈上升趋势（男性每年变化率为 2.5%，女性为 2.9%），随后下降（男性为 4.2%，女性为 3.4%）。与近端癌相比，远端和直肠癌的下降更为陡峭，提示更倾向于进行右侧 CRC 手术。在男性中，筛查实施后，近端手术的筛查前增加趋势被逆转（斜率变化：-6%），而远端（-4%）和直肠（-3%）手术的筛查前下降加速。在女性中，所有部位的筛查前稳定趋势均呈下降趋势（近端手术下降 5%，远端手术下降 8%，直肠手术下降 7%）。然而，无论性别如何，筛查前后时期的趋势变化在解剖部位之间没有差异（所有斜率变化差异在两两比较中均无统计学意义）。
向近端手术的转变可能不仅仅是由于 FIT 的低敏感性造成的，还可能反映了独立于筛查的近端癌症的潜在上升趋势。
