Novotny Sergio A, Rodrigo Amador Vidina A, Seguí Orejuela Jordi, López-Pineda Adriana, Quesada José A, Pereira-Expósito Avelino, Carratalá-Munuera Concepción, Hernandis Villalba Juan, Gil-Guillén Vicente F
Department of General and Digestive Surgery, Elda General University Hospital, Carretera de Sax s/n, 03660 Elda and San Juan de Alicane, Spain.
Department of Clinical Medicine, Miguel Hernández University of Elche, Crta. Nacional 332 s/n, 03550 San Juan de Alicante, Spain.
Cancers (Basel). 2024 Sep 30;16(19):3363. doi: 10.3390/cancers16193363.
Colorectal cancer (CRC) is the leading cause of mortality in Spain, with screening programs, such as the faecal occult blood test and colonoscopy, having shown effectiveness in reducing CRC incidence and mortality. Despite these advancements, CRC screening uptake remains low in Spain, highlighting the need for studies comparing outcomes between screening-diagnosed and symptom-diagnosed patients to better understand the impact on overall survival and to quantify the clinical benefit in prognosis at diagnosis and at the end of follow-up. We conducted a retrospective cohort study with the following objectives: to compare stage at diagnosis, all-cause mortality, and disease-specific mortality among people diagnosed with CRC based on screening and based on symptoms; to identify the risk factors associated with mortality in this population; and to evaluate the effectiveness of screening on survival and early detection. Our study included people diagnosed with CRC in the public hospital of Elda (Spain) from 2014 to 2018; follow-up was until 2023 or death. Our primary outcome was all-cause mortality, which we analysed using Kaplan-Meier curves. We also investigated CRC-specific mortality and other-cause mortality. : Our sample included 315 people (186 with symptom-based diagnoses, 129 with screening-based diagnoses). The mean length of follow-up was 62.8 months. The screening group had a higher prevalence of a family history of CRC ( = 0.008), a distal tumour location ( = 0.002), and a cancer stage of 0 or I ( < 0.001). The symptoms group had a higher prevalence of a proximal CRC ( = 0.002), other chronic diseases ( < 0.001), and stages II, III, and IV ( < 0.001). Two variables were associated with mortality: stage IV at diagnosis and previous cancers. People with a symptom-based diagnosis had a higher prevalence of stage IV at diagnosis and a higher cumulative incidence of CRC mortality and all-cause mortality at the end of follow-up ( < 0.05). The Kaplan-Meier curves also showed a higher rate of all-cause mortality in the symptoms group throughout the follow-up. : CRC screening enables an earlier diagnosis and improves survival. These findings support public health policies that promote accessible and effective screening.
结直肠癌（CRC）是西班牙的主要死因，粪便潜血试验和结肠镜检查等筛查项目已显示出在降低CRC发病率和死亡率方面的有效性。尽管有这些进展，但西班牙的CRC筛查普及率仍然很低，这凸显了进行研究以比较筛查诊断和症状诊断患者的结局的必要性，以便更好地了解对总体生存的影响，并量化诊断时和随访结束时预后的临床益处。我们进行了一项回顾性队列研究，其目标如下：比较基于筛查和基于症状诊断为CRC的人群在诊断时的分期、全因死亡率和疾病特异性死亡率；确定该人群中与死亡率相关的危险因素；评估筛查对生存和早期检测的有效性。我们的研究纳入了2014年至2018年在西班牙埃尔达公立医院诊断为CRC的患者；随访至2023年或死亡。我们的主要结局是全因死亡率，我们使用Kaplan-Meier曲线进行分析。我们还调查了CRC特异性死亡率和其他原因死亡率。我们的样本包括315人（186例基于症状诊断，129例基于筛查诊断）。平均随访时间为62.8个月。筛查组CRC家族史的患病率较高（ = 0.008），肿瘤位于远端的患病率较高（ = 0.002），癌症分期为0或I期的患病率较高（ < 0.001）。症状组近端CRC的患病率较高（ = 0.002），其他慢性病的患病率较高（ < 0.001），II、III和IV期的患病率较高（ < 0.001）。有两个变量与死亡率相关：诊断时为IV期和既往有癌症。基于症状诊断的患者在诊断时IV期的患病率较高，随访结束时CRC死亡率和全因死亡率的累积发生率较高（ < 0.05）。Kaplan-Meier曲线还显示，在整个随访过程中，症状组的全因死亡率较高。CRC筛查能够实现更早的诊断并改善生存。这些发现支持促进可及且有效的筛查的公共卫生政策。
