BACKGROUND The incidence and mortality rates of colorectal cancer (CRC) have been steadily decreasing, largely attributable to screening colonoscopies that either remove precancerous lesions or identify CRC earlier. We aimed to assess the prognostic difference between colorectal cancers diagnosed by screening (SC), diagnostic (DC), or surveillance (SU) colonoscopies. METHODS All 1809 surgically treated patients with primary CRC diagnosed through colonoscopy at our tertiary center (2004-2015) were extracted from a prospectively maintained database. Oncologic outcomes were compared, including multivariate Cox regression. RESULTS Diagnostic patients presented with more advanced disease (15.0% vs. 53.2% (SC) and 55.3% (SU) AJCC I, P < 0.001), subsequently leading to impaired survival and higher recurrence rates (P < 0.001). After adjustment for age, ASA-score and gender, oncologic outcomes remained significantly worse after DC. Hazard ratios (HR) of overall mortality (OS) compared to DC were 0.36 for SC and 0.58 for SU (P < 0.001). Adjusted HRs of disease-free survival (DFS) were 0.43 and 0.32, respectively (P < 0.001). Worse outcomes in OS withstood adjustment for stage, tumor site and (neo)adjuvant treatment (SC: HR 0.46, P < 0.001; SU: HR 0.73, P = 0.036). The benefits of SC were particularly seen in colon cancer, stages I-II and female patients. With regard to DFS, outcomes were less profound and mainly true in early stage disease and surveillance patients. CONCLUSIONS This study demonstrates the enormous impact of asymptomatic screening in CRC. Patients with CRC diagnosed through screening or surveillance had a significantly better prognosis compared to patients who presented symptomatically. This emphasizes the importance of screening.

中文翻译：

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症状检测到的结直肠癌的有害影响。

背景技术结直肠癌（CRC）的发病率和死亡率一直在稳步下降，这主要归因于筛选结肠镜检查，结肠镜检查可以去除癌前病变或更早地识别CRC。我们旨在评估通过筛查（SC），诊断（DC）或监测（SU）结肠镜检查诊断出的大肠癌之间的预后差异。方法我们从前瞻性维护的数据库中提取了我们三级中心（2004-2015年）通过结肠镜检查确诊的所有1809例经手术治疗的原发性CRC患者。比较了肿瘤结局，包括多变量Cox回归。结果诊断患者表现出更严重的疾病（15.0％比53.2％（SC）和55.3％（SU）AJCC I，P <0.001），随后导致生存受损和更高的复发率（P <0.001）。调整年龄，ASA评分和性别后，DC后肿瘤学结局仍显着恶化。与DC相比，总死亡率（OS）的危险比（HR）为SC为0.36，SU为0.58（P <0.001）。调整后的无病生存率（DFS）为0.43和0.32（P <0.001）。OS的恶化结果经受了分期，肿瘤部位和（新）辅助治疗的调整（SC：HR 0.46，P <0.001; SU：HR 0.73，P = 0.036）。SC的益处在结肠癌，I-II期和女性患者中尤为明显。关于DFS，结果不那么深刻，主要在早期疾病和监测患者中是正确的。结论本研究证明了无症状筛查对CRC的巨大影响。与有症状的患者相比，通过筛查或监测诊断出的CRC患者的预后明显更好。这强调了筛选的重要性。