Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy
Matteo Rottoli, Alice Gori, Gianluca Pellino, Maria Elena Flacco, Cecilia Acuti Martellucci, Antonino Spinelli, Gilberto Poggioli, COVID–Colorectal Cancer (CRC) Study Group, Angela Romano, Angela Belvedere, Antonio Lanci Lanci, D Parlanti, Gabriele Vago, Paola Pezzuto, A Canavese, Gerti Dajti, Stefano Cardelli, Caterina Catalioto, Iris S Russo, Tommaso Violante, Daniele Morezzi, Ludovica Maurino, Eleonora Filippone, Dajana Cuicchi, Paolo Bernante, Elio Jovine, Raffaele Lombardi, Michele Masetti, Chiara Cipressi, Maria Fortuna Offi, Cristina Larotonda, Silvana Bernadetta Puglisi, Augusto Barbosa, Roberto Vaiana, Paolo M Bianchi, Carlo Tonti, Claudio Codignola, Luigi Zorcolo, Angelo Restivo, Simona Deidda, Marcello E Marchetti, Luca Ippolito, Gaya Spolverato, Salvatore Pucciarelli, Francesco Marchegiani, Giacomo Ghio, Gaya Zagolin, Dajana Glavas, Monica Tomassi, Riccardo Rosati, Ugo Elmore, Lorenzo Gozzini, Riccardo Calef, Francesco Puccetti, Andrea Cossu, Andrea Vignali, Mario Morino, Marco E. Allaix, Gaspare Cannata, Erica Lombardi, Carlo Alberto Ammirati, Chiara Piceni, P Buccianti, Riccardo Balestri, Marco Puccini, Daniele Pezzati, R D'ischia, Vito F Asta, Benedetta Sargenti, Giacomo Taddei, Federica Bonari, Giulia Boni, Alessandro Ferrero, Michela Mineccia, Federica Gonella, Marco Palisi, Francesco Danese, Valeria Cherubini, Serena Perotti, Michele Carvello, Fabio Carbone, Antonio Luberto, Eleonora Calafiore, Francesca De Lucia, Matteo Sacchi, Diego Sasia, Maria Chiara Giuffrida, Edoardo Ballauri, Mathieu Cardile, Serena Armentano, Elsa Beltrami, Gabriele Preve, Barbara Vercellone, Marta Mozzon, Cristina Folliero, Chiara Lirusso, Massimo Vecchiato, Antonio Ziccarelli, Davide Gattesco, Luisa Moretti
Abstract
Importance: Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. Objective: To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. Design, Setting, and Participants: This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. Exposures: Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. Main Outcomes and Measures: The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. Results: A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95% CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95% CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95% CI, 1.01-1.31; P = .03). Conclusions and Relevance: This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients.