Colorectal Cancer Fast Tracks: Cancer Yield and the Predictive Value of Entry Criteria
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Patient Material
2.2. Data Collection
2.3. Statistical Analysis
3. Results
3.1. Patient Inclusion and Characteristics
3.2. Colonoscopy Outcome
3.3. Performance of SCC-CRC Criteria
3.4. Adjusting for Confounders
3.5. FIT: The New Criterion
3.6. Laboratory Values
4. Discussion
4.1. Cancer Yield
4.2. Predictive Values of Fast-Track Criteria
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Symptom/Sign | Sweden | Norway | Denmark | UK | Italy | Catalonia (Spain) | Valencia (Spain) |
---|---|---|---|---|---|---|---|
Visible blood in stool/rectal bleeding | • | • | • | • | • | • | • |
Anemia | • | • | • | • | • | • | |
Altered bowel habits | • a) | • | • | • | • | • | |
Finding from rectal examination | • | • | • b) | • | • | ||
Weight loss | • c) | • | • | • | |||
Abdominal pain | • | • | |||||
Radiological finding | • | • | |||||
FOBT/FIT | • | • | |||||
Palpable abdominal mass | • | ||||||
Other | • | • | • | • | • | • | |
Maximum days until endoscopy | 10 days | 21 days | 10 (14) days | 2 weeks | 10 days | Not specified |
Study Population 2016–2018 (n = 1271) | Cancer (n = 194) | No Cancer (n = 1077) | p-Value | |
Age, median (IQR) | 72.5 (13) | 70 (19) | <0.001 * | |
Male, n (%) | 101 (52.1) | 489 (45.4) | 0.089 ** | |
Study population 2019–2020 (n = 1268) | Cancer (n = 222) | No cancer (n = 1046) | ||
Age, median (IQR) | 73 (14) | 70 (17) | <0.001 * | |
Male, n (%) | 120 (54.1) | 467 (44.6) | 0.011 ** | |
Study population pooled (n = 2539) | Cancer (n = 416) | No cancer (n = 2123) | ||
Age, median (IQR) | 73 (13) | 70 (17) | <0.001 * | |
Male, n (%) | 221 (53.1) | 956 (45.0) | 0.002 ** |
SCC-CRC Entry Criteria | n (%) | n (%) | PPV (%) | NPV (%) | Specificity (%) | Sensitivity (%) | OR (95% CI) | p-Value |
---|---|---|---|---|---|---|---|---|
SCC-CRC criteria 2016–2018 (n = 1271) | Cancer (n = 194) | No cancer (n = 1077) | ||||||
Visible blood in stool/rectal bleeding | 33 (17.0) | 227 (21.1) | 12.7 | 84.1 | 78.9 | 17.0 | 0.8 (0.5–1.1) | 0.196 |
Anemia (a) | 101 (54.9) | 324 (35.7) | 23.8 | 87.5 | 64.3 | 54.9 | 2.2 (1.6–3.0) | <0.001 |
Abnormal rectal finding (rectoscopy/rectal examination) | 51 (26.3) | 124 (11.5) | 29.1 | 87.0 | 88.5 | 26.3 | 2.8 (1.9–4.0) | <0.001 |
Abnormal radiology | 52 (26.8) | 126 (11.7) | 29.2 | 87.0 | 88.3 | 26.8 | 2.8 (1.9–4.0) | <0.001 |
Altered bowel habits (b) | 81 (41.8) | 582 (54.0) | 12.2 | 81.4 | 46.0 | 41.8 | 0.6 (0.4–0.8) | 0.002 |
SCC-CRC criteria 2019–2020 (n = 1268) | Cancer (n = 222) | No Cancer (n = 1046) | ||||||
Visible blood in stool/rectal bleeding | 57 (25.7) | 286 (27.3) | 16.6 | 82.2 | 72.7 | 25.7 | 0.9 (0.7–1.3) | 0.612 |
Anemia (c) | 122 (56.2) | 351 (39.6) | 25.8 | 84.9 | 60.4 | 56.2 | 2.0 (1.5–2.6) | <0.001 |
Abnormal rectal finding (rectoscopy/rectal examination | 53 (23.9) | 143 (13.7) | 27.0 | 84.2 | 86.3 | 23.9 | 2.0 (1.4–2.8) | <0.001 |
Abnormal radiology | 65 (29.3) | 140 (13.4) | 31.7 | 85.2 | 86.6 | 29.3 | 2.7 (1.9–3.8) | <0.001 |
Combination of altered bowel habits and visible blood in stool/rectal bleeding (d) | 36 (16.2) | 138 (13.2) | 20.7 | 83.0 | 86.8 | 16.2 | 1.3 (0.9–1.9) | 0.234 |
Combination of altered bowel habits and anemia (d) | 50 (22.5) | 127 (12.1) | 28.2 | 84.2 | 87.9 | 22.5 | 2.1 (1.5–3.0) | <0.001 |
SCC-CRC criteria 2016–2020 (n = 2539) | Cancer (n = 416) | No Cancer (n = 2123) | ||||||
Visible blood in stool/rectal bleeding | 90 (21.6) | 513 (24.2) | 14.9 | 83.2 | 75.8 | 21.9 | 0.9 (0.7–1.1) | 0.268 |
Anemia (e) | 223 (55.6) | 675 (37.6) | 24.8 | 86.3 | 62.4 | 55.6 | 2.1 (1.7–2.6) | <0.001 |
Abnormal rectal finding (rectoscopy/rectal examination | 104 (25.0) | 267 (12.6) | 28.0 | 85.6 | 87.4 | 25.0 | 2.3 (1.8–3.0) | <0.001 |
Abnormal radiology | 117 (28.1) | 266 (12.5) | 30.5 | 86.1 | 87.5 | 28.1 | 2.7 (2.1–3.5) | <0.001 |
Altered bowel habits (b) | 187 (45.0) | 1117 (52.6) | 14.3 | 81.5 | 47.4 | 45.0 | 0.7 (0.6–0.9) | 0.004 |
Combination of altered bowel habits and anemia (d) | 83 (20.0) | 234 (11.0) | 26.2 | 85.0 | 89.0 | 20.0 | 2.0 (1.5–2.7) | <0.001 |
Combination of altered bowel habits and visible blood in stool/rectal bleeding (d) | 53 (12.7) | 224 (10.6) | 19.1 | 84.0 | 89.4 | 12.7 | 1.2 (0.9–1.7) | 0.190 |
SCC-CRC Criteria 2016–2018 (n = 1271) | OR (95% CI) | p-Value |
Visible blood in stool/rectal bleeding | 1.6 (1.0–2.5) | 0.066 |
Anemia | 2.2 (1.5–3.1) | <0.001 |
Abnormal rectal finding (rectoscopy/rectal examination) | 4.1 (2.6–6.3) | <0.001 |
Abnormal radiology | 5.0 (3.2–8.0) | <0.001 |
Change in bowel habits | 1.0 (0.7–1.4) | 0.968 |
SCC-CRC criteria 2019–2020 (n = 1268) | ||
Visible blood in stool/rectal bleeding | 0.9 (0.5–1.5) | 0.643 |
Anemia | 2.3 (1.6–3.4) | <0.001 |
Abnormal radiology | 4.6 (3.1–6.9) | <0.001 |
Abnormal rectal finding (rectoscopy/rectal examination) | 3.3 (2.2–5.0) | <0.001 |
Combination of change in bowel habits and anemia | 1.1 (0.7–1.7) | 0.812 |
Combination of change in bowel habits and blood in stool | 2.5 (1.3–4.7) | 0.008 |
SCC-CRC criteria 2016–2020 (n = 2539) | ||
Visible blood in stool/rectal bleeding | 0.9 (0.6–1.4) | 0.705 |
Anemia | 2.1 (1.5–3.0) | <0.001 |
Abnormal radiology | 4.6 (3.4–6.3) | <0.001 |
Abnormal rectal finding (rectoscopy/rectal examination) | 3.6 (2.7–4.8) | <0.001 |
Change in bowel habits | 0.9 (0.6–1.3) | 0.479 |
Combination of change in bowel habits and anemia | 1.1 (0.7–1.8) | 0.669 |
Combination of change in bowel habits and visible blood in stool | 2.5 (1.4–4.5) | 0.001 |
Missing Values, CRC/No CRC (%) | PPV (%) | NPV (%) | p-Values | OR (95% CI) | |||
---|---|---|---|---|---|---|---|
SCC-CRC criteria 2016–2018 (n = 1271) | Cancer (n = 194) | No cancer (n = 1077) | |||||
Positive FIT, n (%) | 84 (98.8) | 402 (68.0) | 56.2/45.1 | 17.3 | 99.5 | <0.001 | 39.5 (5.5–285.8) |
Hb, g/L, median (IQR) - Males - Females | 120 (32) 124 (29) 118 (30) | 130 (26) 136 (27) 128 (23) | 5.2/15.8 8/16.4 2.1/15.3 | N/A | N/A | <0.001 <0.001 <0.001 | N/A |
SCC-CRC criteria 2019–2020 (n = 1268) | Cancer (n = 222) | No Cancer (n = 1046) | |||||
Positive FIT, n (%) | 97 (94.2) | 379 (70.8) | 53.6/48.9 | 20.4 | 96.3 | <0.001 | 6.7 (2.9–15.5) |
Hb, g/L, median (IQR) - Males - Females | 123 (32) 130 (31) 114 (32) | 129 (31) 135 (34) 127 (29) | 2.3/15.3 1.7/15.0 2.9/15.5 | N/A | N/A | 0.005 0.177 <0.001 | N/A |
SCC-CRC criteria 2016–2020 (n = 2539) | Cancer (n = 416) | No cancer (n = 2123) | |||||
Positive FIT, n (%) | 181 (96.3) | 781 (69.4) | 54.8/47.0 | 18.8 | 98.0 | <0.001 | 11.4 (5.3–24.6) |
Hb, g/L, median (IQR) - Males - Females | 122 (32) 128 (31) 116 (30) | 130 (28) 135 (32) 128 (25) | 3.6/15.5 4.5/15.7 2.6/15.4 | N/A | N/A | <0.001 <0.001 <0.001 | N/A |
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Uebel, L.; Kromodikoro, I.; Nyhlin, N.; van Nieuwenhoven, M. Colorectal Cancer Fast Tracks: Cancer Yield and the Predictive Value of Entry Criteria. Cancers 2023, 15, 4778. https://doi.org/10.3390/cancers15194778
Uebel L, Kromodikoro I, Nyhlin N, van Nieuwenhoven M. Colorectal Cancer Fast Tracks: Cancer Yield and the Predictive Value of Entry Criteria. Cancers. 2023; 15(19):4778. https://doi.org/10.3390/cancers15194778
Chicago/Turabian StyleUebel, Linnea, Indy Kromodikoro, Nils Nyhlin, and Michiel van Nieuwenhoven. 2023. "Colorectal Cancer Fast Tracks: Cancer Yield and the Predictive Value of Entry Criteria" Cancers 15, no. 19: 4778. https://doi.org/10.3390/cancers15194778