Objective: To investigate and evaluate the mastery and recognition degree of Chinese clinicians on the 2015 edition of the Chinese Criteria for Diagnosis and Treatment of Colorectal Cancer in order to provide useful suggestions for updating and formulating diagnosis and treatment standards. Methods: Simple random sampling was used to conduct a questionnaire survey in 1500 colorectal cancer-related doctors in general hospitals and cancer hospitals from 115 cities in China. The study included the following guidelines: (1) Chinese Criteria for Diagnosis and Treatment of Colorectal Cancer (2015 edition); (2) Chinese Society of Clinical Oncology Colorectal Cancer Guidelines 2017 (CSCO 2017); (3) National Comprehensive Cancer Network (NCCN) Colon Cancer Guidelines 2017.v1; (4) European Society for Medical Oncology (ESMO) Rectal Cancer Guidelines. The survey was carried out in 2017 and 2019 respectively. In the first phase, the questionnaire included 4 dimensions (guideline cognition, detection and diagnosis, pathology and staging, treatment), and 1500 questionnaires were distributed. In the second phase, the questionnaire contained 3 dimensions (basic information, current treatment status of metastatic colorectal cancer, academic expectations), and 350 questionnaires were distributed. Case (%) was used to indicate the categorical variable data, and chi-square test was used for comparison between groups. P<0.05 indicated that the difference was statistically significant. Results: In the first phase, 1472 valid questionnaires were collected, and the questionnaire efficiency was 98.1% (1472/1500). In the second phase, 337 valid questionnaires were collected, and the questionnaire efficiency was 96.3% (337/350). In the survey of the first phase, doctors had some knowledge and compliance with various guidelines, but the most familiar one was the NCCN guidelines, accounting for 90.7% (1335/1472). In the dimension of detection and diagnosis, the overall correct rate was 64.1% (944/1472). The correct rate of doctors in the first-tier cities was 55.6% (148/266), which was lower than 59.1% (182/308) and 72.9% (369/506) in the second- and the third-tier cities, and the difference was statistically significant (χ(2)=42.140, P<0.001). More than 60.0% (883/1472) of doctors was clear about the specification requirements of the staging evaluation and pathological examination. However, in terms of rectal cancer local staging evaluation, the ratio of doctors who would choose rectal MRI in the first-tier cities was lower than that of those in other tier cities [51.5% (137/266) vs. 65.6% (202/308), 63.2% (320/506) and 61.2% (240/392)], and the difference was statistically significant (χ(2)=41.886, P<0.001). In the dimensions of staging evaluation and pathological examination, there were no statistically significant differences in cognition between general and specialist hospitals (P>0.05). In the treatment dimension, 79.8% (1175/1472) of doctors considered the preoperative treatment as a necessary option for patients with middle and low locally advanced (over cT3) rectal cancer. 46.3% (681/1472) of doctors, including 60.3% (433/718) of surgeons, and 31.4% (225/716) of physicians, had a vague idea that irinotecan could not be used for postoperative adjuvant treatment of colorectal cancer. In the survey of the second phase, 93.8% (316/337) of doctors approved potentially curative systemic (conversion) therapy, and 95.3% (321/337) of doctors followed the clinical guidelines in the treatment of metastatic colorectal cancer. Regarding academic expectations, the clinician's concern for surgery was more practical, and 79.2% (267/337) of doctors wanted to know the best options of conversion therapy for potentially curable metastatic colorectal cancer. In contrast, the clinician's concern for internal medicine was more exploratory, and 80.1% (270/337) of doctors focused on selecting targeted drugs and the sequence of treatment. Conclusions: This investigation has a preliminary understanding of the diagnosis and treatment of colorectal cancer in China. (1) There are many guidelines for doctors' reference, but doctors' understanding of domestic guidelines is not as good as NCCN guidelines. (2) The degree of understanding of the guidelines varies significantly among doctors in different cities. (3) The promotion of guidelines should focus on basic concepts and theories. (4) The detection, diagnosis, and treatment of colorectal cancer should be better trained and promoted. (5) The concept of conversion therapy for metastatic colorectal cancer is highly recognized.
目的： 调研评估我国临床医生对"中国结直肠癌诊疗规范"的掌握和认知程度，以期对更新、制定诊疗规范提供有益的建议。 方法： 采用简单随机抽样方法，调查全国115座城市的三级综合性医院和肿瘤专科医院1 500名结直肠肿瘤相关专业的医生。调查包括的指南规范为：（1）中国结直肠癌诊疗规范（2015版）；（2）中国临床肿瘤学会（CSCO）结直肠癌诊疗指南2017版；（3）美国国家癌症综合网（NCCN）结肠癌诊疗指南2017.V1；（4）欧洲肿瘤内科学会（ESMO）直肠癌指南。调查分别于2017年和2019年两个时间段进行，第1阶段问卷包含4个维度（指南认知、检测与诊断、病理与分期、治疗），发放问卷1 500份；第2阶段问卷包含3个维度（基本情况、转移性结直肠癌治疗现状、学术期望），发放问卷350份。结果数据分类变量资料用例（%）表示，组间比较采用χ(2)检验，P<0.05表示差异有统计学意义。 结果： 本组第1阶段回收有效问卷1 472份，问卷有效率98.1%（1 472/1 500）；第2阶段调查回收有效问卷337份，问卷有效率96.3%（337/350）。第1阶段调查中，结直肠相关专业的医生对各种指南规范都有一定的知晓和依从，但其中最为熟悉的是NCCN指南，医生熟知比例为90.7%（1 335/1 472）。在检查和检验维度方面，回答总体正确率为64.1%（944/1 472），一线城市医生的回答正确率为55.6%（148/266），低于二、三线城市的59.1%（182/308）和72.9%（369/506），差异有统计学意义（χ(2)=42.140，P<0.001）。60.0%（883/1 472）以上的医生清楚分期检查和病理检查的规范要求，但在直肠癌局部分期检查方面，选择盆腔MRI的一线城市医生比例低于其他城市医生[51.5%（137/266）比65.6%（202/308）、63.2%（320/506）和61.2%（240/392）]，差异有统计学意义（χ(2)=41.886，P<0.001）。在检查检验及病理分期的维度方面，综合医院和专科医院医生之间认知的差异没有统计学意义（均P>0.05）。在治疗的维度，对于cT(3)以上的中低位直肠患者，79.8%（1 175/1 472）的医生认为局部进展期直肠癌术前治疗是必要的选择。46.3%（681/1 472）的医生对于伊立替康不能用于结直肠癌术后辅助治疗仍然概念模糊，其中包括了60.3%（433/718）的外科医生和31.4%（225/716）的内科医生。第2阶段调查中，对于潜在可切除的转移性结直肠癌患者，93.8%（316/337）的医生认可转化治疗，95.3%（321/337）的医生在制定治疗策略时，依据临床指南。在学术期望调查方面，临床医生关注的外科问题较实际，79.2%（267/337）的医生希望了解转移性结直肠癌转化治疗的最佳方案；而关注的内科问题更具探索性，80.1%（270/337）医生关注转移性结直肠癌患者靶向药物的选择以及治疗顺序。 结论： 此次调研对国内结直肠癌诊治现状有了初步了解：（1）目前国内结直肠癌诊疗规范选择较多，但医生对国内指南的掌握程度不及NCCN指南；（2）城市之间对指南规范的掌握程度差别较大；（3）规范指南的推广应注重基础概念和理论；（4）应重点规范化推广结直肠癌的检测、诊断和治疗等方面内容；（5）转移性结直肠癌的转化治疗等理念认知度较高。.
Keywords: Cognition; Colorectal neoplasms; Guideline; Sampling survey.