Screening History and 7-Year Survival in 32,099 Colorectal Cancer Patients: A Population-Based Cohort Study

Abstract

Background It is unclear whether colorectal cancer screening history, regardless of stage, is an independent predictor of survival, and if the screening advantage persists after diagnosis. 32 099 patients with colorectal cancer were enrolled in this population-based cohort study. Methods We used data from the Taiwan Cancer Registry on patients with a first-time diagnosis of colorectal cancer between 2013 and 2015. In addition, we utilized data from a nationwide database of colorectal cancer screening programs to evaluate patients’ screening histories, and sourced outcome data from the National Death Registry, tracking patients up to the last day of 2019. Results Compared with fecal immunochemical testing (FIT)-positive patients with a follow-up examination, the adjusted hazard ratios (95% confidence intervals) for death from colorectal cancer were 1.40 (1.26–1.56) for FIT-positive patients without a follow-up examination, 1.63 (1.48–1.78) for FIT-negative patients, and 1.76 (1.65–1.89) for never screened patients. The adjusted hazard ratios for the FIT-positive patients with a follow-up examination increased when diagnosis was delayed by more than 12 months and were 1.2 after a 2-year delay. The adjusted hazard ratios for FIT-negative patients were approximately 2.0, decreased rapidly to 1.6, and stabilized after the 9th time-to-diagnosis month. Conclusion In colorectal cancer patients, screening history prior to diagnosis is an independent prognostic factor, regardless of cancer stage or other variables. This study recommends that physicians take screening history into account during diagnosis to optimize follow-up and management for patients at higher risk.

Screening History and 7-Year Survival in 32,099 Colorectal Cancer Patients: A Population-Based Cohort Study [Response to Letter]

“…We thank Wardoyo and Anwar 1 for their valuable feedback and suggestions on our paper. 2 We agree that a thorough investigation of the relationship between screening history and colorectal cancer survival must encompass patient demographics, lifestyle factors, comorbidities, and treatment approaches.…”

“…In our paper, 2 we analyzed various factors including age at diagnosis, sex, urbanization and hospital levels, colorectal cancer stage and site, treatment, and other clinicopathological variables ( Supplementary Table S8 ), such as grade, tumor size, lymph node ratio, circumferential resection margin, perineural invasion, obstruction, and perforation. Responding to Wardoyo and Anwar, 1 we further adjusted for body mass index, cigarette smoking, alcohol consumption, and family history of colorectal cancer in patients who had been screened.…”

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We thank Wardoyo and Anwar 1 for their valuable feedback and suggestions on our paper. 2 We agree that a thorough investigation of the relationship between screening history and colorectal cancer survival must encompass patient demographics, lifestyle factors, comorbidities, and treatment approaches.In our paper, 2 we analyzed various factors including age at diagnosis, sex, urbanization and hospital levels, colorectal cancer stage and site, treatment, and other clinicopathological variables (Supplementary Table S8), such as grade, tumor size, lymph node ratio, circumferential resection margin, perineural invasion, obstruction, and perforation. Responding to Wardoyo and Anwar, 1 we further adjusted for body mass index, cigarette smoking, alcohol consumption, and family history of colorectal cancer in patients who had been screened.

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Screening History and 7-Year Survival in 32,099 Colorectal Cancer Patients: A Population-Based Cohort Study [Letter]

“…The study provides valuable insights into the screening history and survival outcomes of colorectal cancer patients. 1 This study used sensitivity analysis to assess the stability of the results, adjusted for various colorectal cancer staging systems, and accounted for common biases in screening impact studies, demonstrating a robust methodology. This study provides important insights into the impact of screening history on the survival of colorectal cancer patients, and contributes to the existing knowledge in this field.Despite the advantages, we would like to criticize this study for its lack of detailed information regarding patient demographics, comorbidities, and treatment modalities.…”