Predictors of advanced stage and emergency presentation in colorectal cancer patients in central Scotland: A retrospective cohort study

Background and Aims To determine which factors were associated with and predictive of an advanced stage at diagnosis and emergency mode of presentation in colorectal cancer patients. Methods and Results A total of 587 consecutive patients discussed at multidisciplinary team meetings between January 2017 and December 2019 at an acute hospital in Scotland were included. The effect of predefined variables on stage and mode of presentation was analysed using logistic regression. 55.4% of patients had advanced disease and 19.7% of patients presented as an emergency: these were more likely to have advanced disease (odds ratio (OR) 1.64, 95% confidence interval (95%CI) 1.02–2.62, p = 0.04) compared to the 22.3% diagnosed at screening (OR 0.33, 95%CI 0.21–0.52, p < 0.001). Individuals with affected first-degree relatives were more likely to present with advanced disease (OR 2.39, 95%CI 1.06–5.40, p = 0.04). The association of deprivation and tumour site with advanced disease at presentation was significant ( p = 0.04 and p = 0.013, respectively). The likelihood of presenting as an emergency increased with age (OR 1.03, 95%CI 1.01–1.05, p = 0.003) and with advanced disease (OR 2.15, 95%CI 1.37–3.38, p < 0.001). Again, the relationship between tumour site and emergency presentation was significant ( p = 0.002). Conclusion Further efforts are required to increase screening uptake, particularly amongst higher risk groups, to detect disease at an early stage and reduce the number of patients presenting as emergencies.