The oncologic outcomes of colorectal cancer have worsened during the Covid-19 pandemic: Results of a national multicentre cohort study (COVID-CRC)

ABSTRACT

Aim: Delays in the screening programs for colorectal cancer and the reluctance of patients to seek medical attention due to the outbreak of SARS-CoV- 2 could have resulted in more advanced cancers at diagnosis. The aim of this study was to compare the oncologic outcomes of patients with colorectal cancer in Italy between the pandemic and pre-pandemic periods. Method(s) A retrospective multicentre cohort study of 17,938 patients who underwent surgery for colorectal cancer from March 2020 to December 2021 (pandemic period 7796 patients, 43.5%) and from January 2018 to February 2020 (pre-pandemic period 10,142 patients, 56.5%) in 81 centres. The primary outcome was advanced stage at diagnosis. Secondary outcomes were T4 stage, M stage, aggressive biology, 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. Result(s) At the logistic regression, the SARS-CoV- 2 pandemic period was significantly associated with an increased rate of advanced stage (OR 1.07, 95% CI 1.00-1.13, p = 0.034), distant metastases (OR 1.10, 95% CI 1.00-1.21, p = 0.050), aggressive biology (OR 1.32, 95% CI 1.15-1.53, p < 0.001), and stenotic lesions (OR 1.16, 95% CI 1.02-1.31, p = 0.028). Conclusion(s) The present study reports a significant correlation between the SARSR-CoV- 2 pandemic and the worsening of the oncologic outcomes in patients undergoing surgery for colorectal cancer, and might predict a potential reduction of survival of these patients. An adequate large-scale response is necessary to reduce the impact of the pandemic on colorectal cancer patients' survival.