Pennisi Flavia, Buzzoni Carlotta, Russo Antonio Giampiero, Gervasi Federico, Braga Mario, Renzi Cristina
School of Medicine, University Vita-Salute San Raffaele, Milan, Italy.
PhD National Programme in One Health Approaches to Infectious Diseases and Life Science Research, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
JAMA Netw Open. 2025 May 1;8(5):e258867. doi: 10.1001/jamanetworkopen.2025.8867.
Reducing emergency cancer diagnoses is a public health priority, as they are associated with worse outcomes. Preexisting chronic conditions can influence screening participation and emergency cancer diagnosis; however, evidence is mixed, and data from Southern Europe are scant.
To examine variations in the likelihood of colorectal cancer (CRC) diagnosis following an emergency presentation (EP) or screening by patient comorbidity status and socioeconomic characteristics and to investigate the association of patient characteristics, diagnostic route, and comorbidity status with short-term CRC mortality.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used linked cancer registry data and administrative health data from the Agency for Health Protection of Milan, Italy, for CRC cases diagnosed between July 1, 2014, and December 31, 2020, in the provinces of Milan and Lodi, Italy. Data were analyzed from January 1 to October 1, 2024.
Comorbidity status (number of comorbidities, specific preexisting comorbidities) and socioeconomic characteristics (including age, sex, and deprivation index).
The primary outcomes were routes to cancer diagnosis (screening, emergency presentation, or inpatient or outpatient visits), cancer stage at diagnosis, and short-term mortality (30 days and 1 year). Multivariable and multinomial logistic regression models were used to estimate odds ratios (ORs) adjusted for socioeconomic and comorbidity factors.
Among 14 457 patients, 10 750 (74.4%) had colon cancer and 3707 (25.6%) had rectal cancer. The route to diagnosis was reconstructed for 10 514 patients with colon cancer (97.8%; median age, 73.1 years [IQR, 66-82 years]; 5563 [52.9%] male) and 3635 with rectal cancer (98.1%; median age, 70.3 years [IQR, 62-80 years]; 2079 [57.2%] male). Of those, 4697 patients with colon cancer (44.6%) and 2094 with rectal cancer (57.6%) had comorbidities, emergency diagnosis occurred in 3738 colon (35.6%) and 823 rectal (22.6%) cancer cases, and diagnosis while screening occurred in 881 colon (8.4%) and 347 rectal (9.5%) cancer cases. Emergency diagnosis was associated with having cerebrovascular (adjusted OR [AOR], 1.50; 95% CI, 1.23-1.82) and neurological (AOR, 1.67; 95% CI, 1.33-2.09) diseases or having 3 or more comorbidities compared with having none (AOR, 1.78; 95% CI, 1.47-2.16) among patients with colon cancer. Having 3 or more vs no comorbidities was associated with lower odds of screening-detected colon cancer (AOR, 0.64; 95% CI, 0.45-0.91). Higher 30-day (AOR, 4.84; 95% CI, 2.81-8.33) and 1-year (AOR, 2.77; 95% CI, 2.17- 3.53) mortality was associated with emergency presentation. The COVID-19 period was associated with higher odds of emergency diagnoses compared with the prepandemic period (AOR, 1.32; 95% CI, 1.15-1.52).
In this cohort study of patients with CRC in Italy, emergency diagnosis occurred for more than 1 in 3 patients with colon cancer. Having 3 or more comorbidities was associated with a lower likelihood of screening detection and higher odds of emergency diagnosis. Tailored interventions are needed to facilitate screening, to reduce emergency cancer diagnoses, and to improve outcomes for patients with chronic conditions.
减少癌症急诊诊断是一项公共卫生重点工作，因为此类诊断与更差的预后相关。已有的慢性疾病会影响筛查参与率和癌症急诊诊断；然而，证据并不一致，且来自南欧的数据较少。
按患者的合并症状况和社会经济特征，研究结直肠癌（CRC）在急诊就诊（EP）或筛查后被诊断的可能性差异，并调查患者特征、诊断途径和合并症状况与CRC短期死亡率之间的关联。
设计、设置和参与者：这项基于人群的队列研究使用了意大利米兰卫生保护局的关联癌症登记数据和行政卫生数据，研究对象为2014年7月1日至2020年12月31日期间在意大利米兰和洛迪省诊断出的CRC病例。数据于2024年1月1日至10月1日进行分析。
合并症状况（合并症数量、特定的已有合并症）和社会经济特征（包括年龄、性别和贫困指数）。
主要结局为癌症诊断途径（筛查、急诊就诊、住院或门诊就诊）、诊断时的癌症分期以及短期死亡率（30天和1年）。使用多变量和多项逻辑回归模型来估计经社会经济和合并症因素调整后的比值比（OR）。
在14457例患者中，10750例（74.4%）患有结肠癌，3707例（25.6%）患有直肠癌。对10514例结肠癌患者（97.8%；中位年龄73.1岁[四分位间距，66 - 82岁]；5563例[52.9%]为男性）和3635例直肠癌患者（98.1%；中位年龄70.3岁[四分位间距，62 - 80岁]；2079例[57.2%]为男性）的诊断途径进行了重建。其中，4697例结肠癌患者（44.6%）和2094例直肠癌患者（57.6%）有合并症，3738例结肠癌（35.6%）和823例直肠癌（22.6%）病例为急诊诊断，881例结肠癌（8.4%）和347例直肠癌（9.5%）病例为筛查时诊断。与无合并症的结肠癌患者相比，急诊诊断与患有脑血管疾病（调整后的OR[AOR]，1.50；95%置信区间，1.23 - 1.82）、神经系统疾病（AOR，1.67；95%置信区间，1.33 - 2.09）或有3种或更多合并症（AOR，1.78；95%置信区间，1.47 - 2.16）相关。与无合并症相比，有3种或更多合并症与筛查发现结肠癌的几率较低相关（AOR，0.64；95%置信区间，0.45 - 0.91）。急诊就诊与30天（AOR，4.84；95%置信区间，2.81 - 8.33）和1年（AOR，2.77；95%置信区间，2.17 - 3.53）死亡率较高相关。与疫情前时期相比，COVID - 19时期急诊诊断的几率更高（AOR，1.32；95%置信区间，1.15 - 1.52）。
在这项针对意大利CRC患者的队列研究中，超过三分之一的结肠癌患者为急诊诊断。有3种或更多合并症与筛查发现的可能性较低以及急诊诊断的几率较高相关。需要采取针对性干预措施来促进筛查、减少癌症急诊诊断并改善慢性病患者的预后。
