我国大肠癌的早期发现和临床病理学分期研究

Study on the early detection and clinico-pathologic staging of colorectal cancer in China

Objective To confirm an effective and practicable screening model for early detection of colorectal cancer (CRC), and to modify an acceptable and reasonable staging of CRC for predicting prognosis and to define the therapeutic strategy. Methods Data from 3 case-control studies have been used for selecting the high risk factors of CRC to optimize Sequencing Screening Model (SSM). The fieldwork recalls have been utilized to compare the sensitivity, specificity and Youden Index between the SSM and the optimized one. The 1722 individuals have been used to evaluate the Optimized Sequencing Screening Model (OPSM). From 1980 to 1995, 1334 cases of CRC pathologically confirmed have been analyzed for 3-, 5- and 10-year survival rates. All tests were performed at the 0.05 level of significances. Statistical analysis was conducted by using the SPSS 10.0 statistic software. Results A simple questionnaire and RPHA-FOB test as the screening model for early detecting CRC had been proved as an optimized screening model. The sensitivity, specificity and Youden Index of the optimized model were higher than those of SSM. From the 1722 individuals 4 Dukes' A and 5 Dukes' B CRC were screened out. Analysis of the 3-, 5- and 10-year survival rates revealed that there were statistically significant differences between serosa and extraserosa. The 3-, 5- and 10-year survival rates were 0.91±0.06, 0.84±0.07, 0.81±0.07 respectively in cancer involved to the serosa group, but in extraserosa group the survival rates were 0.82±0.03, 0.74±0.03, 0.63±0.04 respectively. The survival rate of serosa level involved was higher than that of extraserosa and/or rectum wall fat. Therefore, these two levels should be separated in the clinico-pathologic staging of CRC. Conclusion The optimized screening model is suitable to early detection of the CRC. Due to different survival rates of different layers involved, the Dukes B (or stage II) should be divided into Dukes B1 or stage II a (serosa) and Dukes B2 or stage IIb (extraserosa or bowel wall fat).