Background and Aims

Screening for colorectal cancer (CRC) aims to decrease CRC incidence and mortality. Biennial fecal immunochemical test screening started in the Netherlands in 2014 for individuals 55–75 years of age. This study investigated the effect of screening on stage-specific incidence, with focus on stage III and IV CRC.

Methods

Inhabitants diagnosed with CRC in 2009–2018 were included. CRC incidence per stage, year, and detection method (ie, screen-detected vs clinically detected) was evaluated. Patient, tumor, and treatment characteristics, and survival of patients with stage III and IV CRC, were compared according to the detection method.

Results

Included were 140,649 CRCs in 136,882 patients. An initial peak of stage I–III CRC diagnoses after initiation of screening was followed by a continuous decrease within screening-eligible ages. Total CRC incidence remained higher than before screening, although stage II and IV CRC incidence decreased below prescreening levels. Screen-detected CRCs were significantly more frequently located in the left-sided colon (stage III; 43.7% vs 30.9%; stage IV: 45.1% vs 36.1%), and the primary tumor resection rate was higher (stage III colon: 99.8% vs 99.0%, rectum: 97.3% vs 89.7%; stage IV colon: 65.4% vs 56.6%, rectum: 47.3% vs 33.5%). Patients with screen-detected stage IV CRC had significantly more often single-organ metastases (74.5% vs 57.0%; P < .001) and more frequently received treatment with curative intent (colon: 41.3% vs 27.4%; rectum: 33.8% vs 24.6%). Overall survival significantly improved for patients with screen-detected CRCs (stage III: P < .001; stage IV: P < .001).

Conclusions

Five years after the start of a nationwide CRC screening program, a decrease in stage II and IV CRC incidence was observed. Patients with screen-detected stage III and stage IV CRC had less extensive disease and improved survival compared with those with clinically detected CRC.

中文翻译：

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国家 CRC 筛查对发病率和晚期结直肠癌的初步影响

背景和目标

结直肠癌 (CRC) 筛查旨在降低 CRC 的发病率和死亡率。荷兰于 2014 年开始对 55-75 岁的个体进行两年一次的粪便免疫化学测试筛查。本研究调查了筛查对特定阶段发病率的影响，重点是 III 期和 IV 期 CRC。

方法

包括 2009-2018 年被诊断患有 CRC 的居民。评估了每个阶段、年份和检测方法（即筛查检测与临床检测）的 CRC 发病率。根据检测方法比较 III 期和 IV 期 CRC 患者的患者、肿瘤和治疗特征以及生存期。

结果

包括 136,882 名患者中的 140,649 个 CRC。筛查开始后 I-III 期 CRC 诊断的初始峰值随后在符合筛查条件的年龄段内持续下降。尽管 II 期和 IV 期 CRC 发病率低于筛查前水平，但总 CRC 发病率仍高于筛查前。屏幕检测到的 CRC 明显更多地位于左侧结肠（III 期；43.7% vs 30.9%；IV 期：45.1% vs 36.1%），原发肿瘤切除率更高（III 期结肠：99.8% vs 99.0%，直肠：97.3% vs 89.7%；IV 期结肠：65.4% vs 56.6%，直肠：47.3% vs 33.5%）。筛查检测到 IV 期 CRC 的患者单器官转移的频率明显更高（74.5% 对 57.0%；P <.001) 并且更频繁地接受具有治愈目的的治疗（结肠：41.3% 对 27.4%；直肠：33.8% 对 24.6%）。筛查检测出 CRC 的患者的总体生存率显着提高（III 期：P < .001；IV 期：P < .001）。

结论

在全国范围内开展 CRC 筛查计划五年后，观察到 II 期和 IV 期 CRC 发病率有所下降。与临床检测到的 CRC 患者相比，筛查检测到的 III 期和 IV 期 CRC 患者的疾病范围更小，生存率更高。