Background: Fast-track pathways for diagnosing colorectal cancer (CRC) have been implemented in several European countries. In Sweden, a substantial number of CRC are diagnosed via the Swedish Standardized Course of Care for colorectal cancer (SCC-CRC). We evaluated the SCC-CRC in terms of CRC yield, and predictive values and odds ratios (OR) for the entry criteria. Methods: We retrospectively analyzed all 2539 patients referred for SCC-CRC colonoscopy between September 2016 and December 2020. Entry criteria and colonoscopy outcomes were analyzed. Results: CRC yield was 16.4%. Highest positive predictive values (PPVs) were seen for abnormal radiology (PPV 30.5%, OR 4.7 (95% CI 3.4–6.4)p< 0.001), abnormal rectal examination (PPV 28%, OR 3.6 (95% CI 2.7–4.8)p< 0.001), and anemia (PPV 24.8%, OR 2.2 (95% CI 1.5–3.1)p< 0.001). Some entry criteria showed no significant risk increase, i.e., visible blood in stool/rectal bleeding, change in bowel habits, and the combination of changed bowel habits plus anemia. A positive fecal immunochemical test (FIT), although not part of the SCC-CRC, showed the highest OR: 9.9 (95% CI 4.5–21.7)p< 0.001) and PPV of 18.8%. Conclusions: CRC yield from the SCC-CRC is slightly higher compared to other European fast tracks. A number of entry criteria showed no benefit towards assessing CRC risk. FIT testing should be included in CRC fast tracks to increase diagnostic efficacy.
背景：结直肠癌（CRC）的快速诊断路径已在多个欧洲国家实施。在瑞典，大量CRC病例通过瑞典结直肠癌标准化诊疗流程（SCC-CRC）进行诊断。本研究从CRC检出率、入组标准的预测价值及比值比（OR）角度对SCC-CRC进行评估。方法：回顾性分析2016年9月至2020年12月期间所有转诊至SCC-CRC结肠镜检查的2539例患者，对其入组标准与结肠镜检查结果进行分析。结果：CRC总体检出率为16.4%。影像学异常（阳性预测值30.5%，OR 4.7 [95% CI 3.4–6.4]，p<0.001）、直肠指检异常（阳性预测值28%，OR 3.6 [95% CI 2.7–4.8]，p<0.001）及贫血（阳性预测值24.8%，OR 2.2 [95% CI 1.5–3.1]，p<0.001）具有最高的阳性预测值。部分入组标准未显示显著风险增加，包括肉眼血便/直肠出血、排便习惯改变，以及排便习惯改变合并贫血。虽未纳入SCC-CRC标准，但粪便免疫化学检测（FIT）阳性显示出最高的OR值（9.9 [95% CI 4.5–21.7]，p<0.001）及18.8%的阳性预测值。结论：SCC-CRC的CRC检出率略高于其他欧洲快速诊断路径。部分入组标准对评估CRC风险无显著增益。建议将FIT检测纳入CRC快速诊断路径以提高诊断效能。
Colorectal Cancer Fast Tracks: Cancer Yield and the Predictive Value of Entry Criteria
肿瘤(癌症)患者之家