IMPACT OF FIT-BASED CRC POPULATION SCREENING PROGRAM ON THE MANAGEMENT OF PT1 COLORECTAL CANCER

Aims To compare the characteristics and management of pT1 Colorectal Cancer (CRC) diagnosed within and outside a Faecal Immunochemical Test-based population CRC screening program.

Methods Retrospective, multicenter, Nation-based, cohort study (EpiT1 consortium) including all pT1 CRC cases diagnosed between 2007-2018 regardless of the treatment received. Multivariate analysis was performed using binary logistic and Cox regression.

Results From a sample of 3649 patients, 3163 were finally included for the analysis: 1417(45%) of them diagnosed within a FIT-based population CRC screening program and 1745(55%) outside of it. Baseline patients, colonoscopy and lesions characteristics were significantly different in both groups with more males (65% vs 59% p=0.001), younger age (61.9±6.6 vs 68.8±10.9 p=0.001), less comorbidity (ASA I and II) (85% vs 66% p<0.001), more adequate bowel preparation (94% vs 84% P<0.001), major cecal intubation rate (97% vs 91% p<0.001), small lesion size(21.2±10.9 vs 25.4±14, 1 p=0.001) and distal tumor location (86% vs 78% p<0.001) in the FIT-based screening group. The primary and definitive management of the lesions was different in both groups (image). The screening programme was independently associated to a higher primary and definitive endoscopic treatment ([Table 1]). The overall and CRC adjusted survival in the screening group vs the rest were 93.3% vs 80.3% and 98,5% vs 97,2%, respectively.

Table 1

		Primary endoscopic treatment Adjusted OR (95%CI)	Secondary surgical treatment Adjusted OR (95%CI)	Definitive endoscopic treatment Adjusted OR (95%CI)
INDICATION	FIT-based Population Screening Program	1,6 (1,25 – 2,07)	0,90 (0,73 – 1,10)	1,23 (1,01 – 1,49)
PATIENT CHARACTERISTICS	Age (Over 65 yo)	0,3 (0,23 – 0,38)	0,70 (0,57 – 0,85)	1,29 (1,07 – 1,57)
	Degree of comorbidity (ASA III-IV)	1,29 (0,98 – 1,70)	0,75 (0,59 – 0,95)	1,35 (1,08 – 1,68)
LESION CHARACTERISTICS	Size (Greater than 20 mm)	0,3 (0,23 – 0,38)	1,52 (1,25 -1,85)	0,48 (0,40 – 0,58)
	Location (Distal to splenic angle)	2,4 (1,84- 3,15)	0,50 (0,36 – 0,69)	2,55(1,90 – 3,43)
	Lesion Morphology (pedunculated)	7,17 (5,29 – 9,72)	0,38 (0,31 – 0,47)	3,81(3,18 – 4,58)

Fig. 1

Conclusions pT1 CRC detected in the setting of a FIT-based population screening program are more often managed with endoscopic resection as primary and definitive treatment without impact on disease-free survival.

Publication History

Article published online:
14 April 2022