Background and objective: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.Methods: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.Results: 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 (p= 0.008), a distal tumour location (p= 0.002), and a cancer stage of 0 or I (p< 0.001). The symptoms group had a higher prevalence of a proximal CRC (p= 0.002), other chronic diseases (p< 0.001), and stages II, III, and IV (p< 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 (p< 0.05). The Kaplan–Meier curves also showed a higher rate of all-cause mortality in the symptoms group throughout the follow-up.Conclusion: CRC screening enables an earlier diagnosis and improves survival. These findings support public health policies that promote accessible and effective screening.
背景与目的：结直肠癌是西班牙的主要致死原因，粪便潜血试验和结肠镜检查等筛查项目已被证实能有效降低结直肠癌的发病率和死亡率。尽管取得这些进展，西班牙的结直肠癌筛查参与率仍然较低，这凸显了比较筛查诊断与症状诊断患者结局研究的必要性，以更好地理解筛查对总生存期的影响，并量化诊断时及随访结束时对预后的临床获益。 方法：我们开展了一项回顾性队列研究，旨在：比较基于筛查和基于症状诊断的结直肠癌患者在诊断时的分期、全因死亡率和疾病特异性死亡率；识别该人群中与死亡率相关的风险因素；评估筛查对生存期和早期检测的有效性。研究纳入2014年至2018年间在西班牙埃尔达公立医院诊断为结直肠癌的患者，随访持续至2023年或患者死亡。主要结局指标为全因死亡率，采用Kaplan-Meier曲线进行分析。同时研究了结直肠癌特异性死亡率及其他原因死亡率。 结果：研究样本共纳入315例患者（186例为症状诊断，129例为筛查诊断）。平均随访时间为62.8个月。筛查组具有更高的结直肠癌家族史发生率（p=0.008）、远端肿瘤位置比例（p=0.002）以及0期或I期癌症比例（p<0.001）。症状组则具有更高的近端结直肠癌比例（p=0.002）、其他慢性疾病患病率（p<0.001）以及II期、III期和IV期比例（p<0.001）。两个变量与死亡率相关：诊断时为IV期和既往癌症史。症状诊断患者在诊断时IV期比例更高，且在随访结束时结直肠癌死亡率和全因死亡率的累积发生率更高（p<0.05）。Kaplan-Meier曲线也显示在整个随访期间症状组的全因死亡率更高。 结论：结直肠癌筛查能够实现更早诊断并提高生存率。这些发现支持促进可及且有效筛查的公共卫生政策。
肿瘤(癌症)患者之家