Abstract
BackgroundScreening significantly reduces mortality from colorectal cancer (CRC). Screen detected (SD) tumors associate with better prognosis, even at later stage, compared to non-screen detected (NSD) tumors. We aimed to evaluate the association between diagnostic modality (SD vs. NSD) and short- and long-term outcomes of patients undergoing surgery for CRC.Materials and MethodsThis retrospective cohort study involved patients aged 50–69 years, residing in Veneto, Italy, who underwent curative-intent surgery for CRC between 2006 and 2018. The clinical multi-institutional dataset was linked with the screening dataset in order to define diagnostic modality (SD vs. NSD). Short- and long-term outcomes were compared between the two groups.ResultsOf 1,360 patients included, 464 were SD (34.1%) and 896 NSD (65.9%). Patients with a SD CRC were more likely to have less comorbidities (p = 0.013), lower ASA score (p = 0.001), tumors located in the proximal colon (p = 0.0018) and earlier stage at diagnosis (p < 0.0001). NSD patients were found to have more aggressive disease at diagnosis, higher complication rate and higher readmission rate due to surgical complications (all p < 0.05). NSD patients had a significantly lower Disease Free Survival and Overall Survival (all p < 0.0001), even after adjusting by demographic, clinic-pathological, tumor, and treatment characteristics.ConclusionsSD tumors were associated with better long-term outcomes, even after multiple adjustments. Our results confirm the advantages for the target population to participate in the screening programs and comply with their therapeutic pathways.
Highlights
Colorectal cancer (CRC) represents one of the leading causes of cancer death in Western countries
The objective of the current study was to evaluate the impact of diagnostic modality (SD vs. non-screen detected (NSD)) on short-term outcomes, long-term outcomes, and on the quality of the therapeutic pathway of patients undergoing surgery for CRC
For the purposes of this study, all patients with a CRC diagnosed at colonoscopy following a positive screening fecal immunochemical testing (FIT) were considered Screen detected (SD), while all other CRC patients in the same age range were considered as non-screen detected (NSD)
Summary
Colorectal cancer (CRC) represents one of the leading causes of cancer death in Western countries. Screening based on the Fecal Occult Blood Test (FOBT) has been shown to significantly reduce the risk of mortality from CRC [3,4,5,6]. In 2003 the European Council recognized FOBT as a valuable and effective screening method and recommended the implementation of organized CRC screening in all European countries [10]. The higher sensitivity and specificity of fecal immunochemical testing (FIT) compared with guaiac FOBT for the detection of advanced adenomas and CRC was established [11], yielding a high effectiveness in reducing mortality as well as incidence of CRC [12, 13]. Screening significantly reduces mortality from colorectal cancer (CRC). We aimed to evaluate the association between diagnostic modality (SD vs. NSD) and short- and long-term outcomes of patients undergoing surgery for CRC
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