Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia.
Clinical Epidemiology Program, Master of Clinical Medicine Postgraduate Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Asian Pac J Cancer Prev. 2024 Aug 1;25(8):2813-2821. doi: 10.31557/APJCP.2024.25.8.2813.
In Indonesia incidence of colorectal cancer (CRC) remains high. Information about early symptoms that can offer clinicians insights for timely diagnosis, prompt referral and quick treatment decisions is very limited. This study aims to examine the pattern of CRC early symptoms and its association with tumor laterality, age at onset, metastatic status, and symptom-to-treatment initiation (STI) duration and delay.
This cross-sectional study recruits 258 patients diagnosed with CRC between November 2022 and October 2023 from two distinct study databases. Patient baseline characteristics were also obtained from medical records and through interviews at baseline. Symptom-to-treatment initiation (STI) duration was defined as the number of days between the date of the symptom's onset and the date of the first treatment's initiation. Relative risk estimation for metastatic disease and the STI delay, based on tumor laterality and the age at onset group, were estimated using a log-binomial regression for each early symptom.
Experiencing abdominal mass as an early symptom is significantly associated with metastatic disease, specifically in right-sided CRC cases (relative risk/RR=2.08, 95% confidence interval/CI 1.29-3.37, p=0.003). In all study subjects, the median STI duration was 182 days (2-5,082 days), with more than half of the subjects experiencing an STI delay of >180 days. Experiencing rectal mass as an early symptom is significantly associated with a higher risk of STI delay >180 days in early onset CRC (RR=1.97, 95% CI 1.27-3.06, p=0.003) and left sided-CRC cases (RR=1.54, 95% CI 1.13-2.08, p=0.005). The non-specific early symptom of weight loss is associated with a higher risk of STI delay >180 days in right-sided CRC cases (RR=1.73, 95% CI 1.06-2.84, p=0.029).
The findings underlined the importance of maintaining a high clinical suspicion, particularly in patients with rectal masses and unexplained weight loss, as they might experience STI delay.
在印度尼西亚，结直肠癌（CRC）的发病率仍然很高。有关可帮助临床医生及时诊断、快速转诊和快速治疗决策的早期症状的信息非常有限。本研究旨在探讨 CRC 早期症状的模式及其与肿瘤侧别、发病年龄、转移状态以及症状治疗开始时间（STI）持续时间和延迟的关系。
本横断面研究招募了 2022 年 11 月至 2023 年 10 月期间从两个不同研究数据库诊断为 CRC 的 258 名患者。还从病历和基线访谈中获取了患者的基线特征。症状治疗开始时间（STI）持续时间定义为症状出现日期与首次治疗开始日期之间的天数。基于肿瘤侧别和发病年龄组，使用对数二项式回归对每个早期症状的转移性疾病和 STI 延迟的相对风险估计进行了估计。
出现腹部肿块作为早期症状与转移性疾病显著相关，特别是在右侧 CRC 病例中（相对风险/ RR=2.08，95%置信区间/ CI 1.29-3.37，p=0.003）。在所有研究对象中，中位 STI 持续时间为 182 天（2-5082 天），超过一半的患者 STI 延迟>180 天。出现直肠肿块作为早期症状与早期发病的 CRC 中 STI 延迟>180 天的风险显著相关（RR=1.97，95% CI 1.27-3.06，p=0.003）和左侧 CRC 病例（RR=1.54，95% CI 1.13-2.08，p=0.005）。非特异性早期体重减轻症状与右侧 CRC 病例中 STI 延迟>180 天的风险增加相关（RR=1.73，95% CI 1.06-2.84，p=0.029）。
这些发现强调了保持高度临床怀疑的重要性，特别是在出现直肠肿块和不明原因体重减轻的患者中，因为他们可能会出现 STI 延迟。
