Guo Lanwei, Wang Le, Cai Lin, Zhang Yuelun, Feng Xiaoshuang, Zhu Chenxin, Gao Wendong, Cardoso Rafael, Yang Haiyan, Dai Min, Brenner Hermann, Chen Hongda
Department of Clinical Research Management, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China; Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, China.
Department of Cancer Prevention, Zhejiang Cancer Hospital, Hangzhou, China.
Clin Gastroenterol Hepatol. 2024 Dec 16. doi: 10.1016/j.cgh.2024.11.019.
BACKGROUND & AIMS: Stage at diagnosis is a key prognostic factor for colorectal cancer (CRC) survival. We aimed to assess the global distribution of CRC staging at diagnosis using population-based or hospital-based registry data.
We systematically searched in MEDLINE and Embase from their inception until December 6, 2023. Gray literature was searched through published cancer reports. Studies from population-based or hospital-based cancer registries reporting the stage distribution of diagnosed CRC were included. We extracted stage-specific proportions among patients with CRC based on TNM; Surveillance, Epidemiology, and End Results; or Dukes staging systems. Subgroup analyses by sex, age, tumor site, calendar period, and status of population-based screening were performed. Correlations between the Human Development Index (HDI), Socio-Demographic Index (SDI), and the distant metastatic CRC proportion were also evaluated.
A total of 84 eligible studies/reports from 46 countries were analyzed, covering 3.8 million patients. Among 36 countries included in the main analysis, the most recent distant metastatic CRC proportions varied from 16.2% in Puerto Rico to 28.2% in Oman and Latvia, with a median of 23.7% (interquartile range, 21.8%-26.3%). Higher metastatic proportions were observed in younger patients, those with colon cancer, and those without screening implementation, with no apparent difference between males and females. Over time, some countries/regions, such as Southern Portugal (36.5% in 2000 to 22.2% in 2016), showed declining proportions of metastatic CRC, whereas others remained stable (eg, Austria, Belgium) or increased (eg, United States, Slovenia, Spain). Higher HDI and SDI were correlated with lower proportions of distant metastatic CRC (HDI: ρ = -0.48; SDI: ρ = -0.26).
Global disparities in CRC staging exist, indicating a need for targeted interventions to enhance early detection and management, especially in high-metastasis areas.
诊断时的分期是结直肠癌（CRC）生存的关键预后因素。我们旨在利用基于人群或基于医院的登记数据评估CRC诊断时分期的全球分布情况。
我们系统检索了MEDLINE和Embase数据库，检索时间从数据库建立至2023年12月6日。通过已发表的癌症报告检索灰色文献。纳入基于人群或基于医院的癌症登记处报告的已诊断CRC分期分布的研究。我们根据TNM、监测、流行病学和最终结果或Dukes分期系统提取CRC患者中特定分期的比例。按性别、年龄、肿瘤部位、日历时间和基于人群的筛查状态进行亚组分析。还评估了人类发展指数（HDI）、社会人口学指数（SDI）与远处转移性CRC比例之间的相关性。
共分析了来自46个国家的84项符合条件的研究/报告，涵盖380万患者。在纳入主要分析的36个国家中，最近远处转移性CRC比例从波多黎各的16.2%到阿曼和拉脱维亚的28.2%不等，中位数为2323.7%（四分位间距，21.8%-26.-3%）。在年轻患者、结肠癌患者和未实施筛查的患者中观察到更高的转移比例，男性和女性之间无明显差异。随着时间的推移，一些国家/地区，如葡萄牙南部（2000年为36.5%，2016年为22.2%），远处转移性CRC比例呈下降趋势，而其他国家/地区保持稳定（如奥地利、比利时）或上升（如美国、斯洛文尼亚、西班牙）。较高的HDI和SDI与较低的远处转移性CRC比例相关（HDI：ρ=-0.48；SDI：ρ=-0.26）。
CRC分期存在全球差异，这表明需要采取有针对性的干预措施来加强早期检测和管理，尤其是在高转移地区。
