2019—2020年湖南省城市居民结直肠癌筛查参与率、病变检出率及其影响因素分析

摘 要：［目的］ 分析湖南省城市癌症早诊早治项目中部分结直肠癌高危人群的结肠镜检查参与率和病变检出情况及其相关影响因素。［方法］ 基于2019—2020年湖南省城市癌症早诊早治项目,纳入部分符合研究要求的45~74岁受试者。所有受试者均接受流行病学问卷调查并进行癌症风险评估,推荐评估结果为结直肠癌高风险的人群在项目医院进行结肠镜检查。采用χ2检验比较一般人群和结直肠癌高危人群的特征差异;采用Logistic回归模型分析与结肠镜检查参与率相关的影响因素以及与结肠肿瘤检出率相关风险因素。［结果］ 22 893名筛查目标人群中,1 926名被判定为结直肠癌高风险,高风险率为8.4%。523名高风险人群按照研究要求接受了结肠镜检查,参与率为27.2%。多因素Logistic回归分析结果提示年龄、吸烟史、运动习惯和肠道疾病家族史是结肠镜检查参与率的影响因素。523名接受结肠镜检查的受试者中检出各类结直肠肿瘤142例（27.2%）。 多因素Logistic回归分析结果提示年龄和吸烟史是结直肠肿瘤检出率的影响因素,与45~49岁人群相比,60~64岁（OR=2.90,95%CI：1.25~7.22）以及65~69岁（OR=2.93,95%CI：1.24~7.43）人群结肠镜肿瘤检出率显著升高;与不吸烟人群相比,吸烟或已戒烟的人群（OR=1.90,95%CI：1.10~3.36）结肠镜肿瘤检出率更高。［结论］ 湖南省城市地区高危人群的结直肠癌筛查参与率仍处于较低水平,但在高危人群开展结肠镜筛查可检出较高比例的结直肠肿瘤,取得了较好的筛查效果。在未来的人群结直肠癌筛查项目中,对特定高风险群体开展健康宣教,提高其防癌健康素养和筛查参与率是亟待解决的关键问题。     

结直肠癌根治术后并发静脉血栓栓塞的危险因素分析

目的 探究结直肠癌根治术后并发静脉血栓栓塞(VTE)的危险因素.方法 选择行结直肠癌根治术患者200例作为研究对象,根据患者是否发生VTE分为VTE组(16例)及非VTE组(184例),分析结直肠癌术后并发VTE的相关危险因素.结果 患者年龄≥60岁、男性、有VTE既往病史、呼吸系统疾病、心血管疾病、手术时间、术中出血...     

结直肠癌危险因素及临床流行病学特征研究

目的探讨结直肠癌危险因素及临床流行病学特征。方法回顾性分析1 860结直肠癌患者的临床资料,分析其流行病学特征,并与1 725例非肿瘤患者进行对照分析,比较引发结直肠癌的主要危险因素。结果结直肠癌患者在性别、年龄、年份、原发病灶部位及病理类型分布上存在显著差异(P<0.05);结直肠癌组患者与对照组在基础疾病、结直肠癌家族史、胆囊切除手术史、阑尾切除术史上存在显著差异(P<0.05),进一步进行单因素和多因素logistic分析发现,糖尿病、高血压、结直肠癌家族史和阑尾切除术史均可能为诱发结直肠癌的危险因素,糖尿病和结直肠癌家族史为诱发结直肠癌的主要危险因素。结论结直肠癌高危发病人群为男性,发病年龄集中于中老年人群,原发病灶部位主要位于直肠,病理类型多为管状腺癌,糖尿病和结直肠癌家族史为诱发结直肠癌的主要危险因素。     

广州市结直肠癌及癌前病变患者疾病经济负担及影响因素分析

摘 要：［目的］ 对广州市结直肠癌及癌前病变患者进行疾病经济负担调查,并分析影响因素,为后期成本效果评价提供依据。［方法］ 整群抽取广州市辖范围内的教育部附属、省、市属的4家三级医疗机构,采用问卷调查和病案摘录相结合的方式调查结直肠癌及癌前病变患者（家属）相关人口社会学信息、临床信息、医疗及非医疗费用信息等。［结果］ 广州市结直肠癌前病变患者的例均直接医疗费用、直接非医疗费用、间接费用和总费用分别为14 437元、1268元、7967元和23 672元,结直肠癌患者的例均直接医疗费用、直接非医疗费用、间接费用和总费用分别为135 258元、10 268元、27 363元和172 888元。多因素分析显示,临床分期、治疗方案、住院次数和住院天数对直接医疗费用和总费用有明显影响。癌前病变的费用最低,癌症临床期别越晚,费用越高;单纯手术治疗费用最低;住院次数越多,住院天数越长费用越高。非广州市来源的患者直接非医疗费用和间接费用比广州市来源的患者高。拥有医疗保险的患者比其他患者间接费用更高。［结论］ 广州市结直肠癌患者的疾病经济负担重,有必要进一步加强健康教育宣传,大力推进结直肠癌筛查工作,通过发现并切除腺瘤,降低未来结直肠癌的发病率,同时提高结直肠癌的早发现、早诊断、早治疗比例,对于降低结直肠癌对社会和家庭的经济负担和社会负担,具有重大意义。     

腹腔镜下结直肠癌根治术危险因素及并发症分析

目的 探讨腹腔镜下结直肠癌根治术的危险因素以及疗效.方法 收集腹腔镜下行结直肠癌根治本的患者102例,并选取40例常规开腹手术患者作为对照组,对比分析影响其手术的危险因素以及患者近远期并发症情况.结果 对腹腔镜下结直肠癌术后并发症危险因素行Logistic回归分析发现,患者的TNM分期、伴发心肺疾患、肝肾功能不全以及术中出血量≥100 ml为其独立危险因素.对比分析两组手术方式患者近远期并发症,差异不具统计学意义(P＞0.05).腹腔镜组患者与对照组相比,两者在手术时间、术中出血量、术后首次排气时间、术后进食时间以及住院时间上差异显著,具有统计学意义(P＜0.05).两者在淋巴结清扫个数上差异不具统计学意义(P＞0.05).结论 腹腔镜值得广泛应用于结直肠癌的治疗中.     

内镜黏膜下剥离术治疗早期结直肠癌、癌前病变术后迟发性出血的相关危险因素分析

目的 探讨内镜黏膜下剥离术(ESD)治疗早期结直肠癌、癌前病变术后迟发性出血的相关危险因素。方法 回顾性分析118例早期结直肠癌、癌前病变患者的临床资料,入选者均进行ESD治疗。根据患者ESD术后有无出现迟发性出血分为出血组与正常组,统计两组临床资料,分析早期结直肠癌、癌前病变患者ESD术后迟发性出血的危险因素。结果 118例早期结直肠癌、癌前病变患者均顺利完成ESD治疗,术后2～7天内陆续出现出血,共10例,发生率为8.47%(10/118);出血组肿瘤位于直肠、重度纤维化、侵袭深度≥1000μm、术中出血占比均高于正常组,差异有统计学意义(P<0.05);两组性别、年龄、合并心血管疾病、合并高血压、肿瘤数目、肿瘤形态等对比,差异无统计学意义(P>0.05);Logistic回归分析：肿瘤位于直肠、重度纤维化、侵袭深度≥1000μm、术中出血是ESD术后迟发性出血的独立危险因素(P<0.05且OR≥1)。结论 早期结直肠癌、癌前病变患者经ESD治疗后易出现术后迟发性出血,肿瘤位于直肠、重度纤维化、侵袭深度≥1000μm、术中出血是ESD术后迟发性出血独立影响因素,临...     

结直肠癌术后肝转移的危险因素分析及预测模型构建

目的:分析结直肠癌术后肝转移的危险因素并构建预测模型.方法:选取2011年1月至2015年12月于苏州市第九人民医院行根治性手术切除的247例结直肠癌患者作为观察对象,依据随访是否出现肝转移分为转移组、非转移组.对两组各项指标进行单因素筛选,再行Logistic多因素回归分析,并建立预测模型,应用受试者工作特征(rec...     

结直肠癌根治术后并发静脉血栓栓塞的相关危险因素分析

目的 研究结直肠癌根治术后发生静脉血栓栓塞（venous thromboembolism,VTE）的相关危险因素,以期指导预防和治疗。 方法 选取2017年1月1日至2018年12月31日在四川省肿瘤医院行结直肠癌根治术后发生VTE的患者16例、同期未发生VTE的患者198例,采用单因素和多因素Logistic回归分析结直肠癌根治术后并发静脉血栓栓塞的相关危险因素。 结果 经单因素分析,非VTE组和VTE组患者在年龄、既往VTE病史、2型糖尿病、心血管疾病、高脂血症、手术时间、感染、术后制动时间、静脉穿刺次数上存在统计学差异（P<0.05）;而在性别、是否吸烟、是否嗜酒、BMI、是否合并呼吸系统疾病、术前是否放化疗、AJCC分期、肿瘤部位、术中出血、是否输血上无统计学差异。将单因素整理出的相关危险因素进行赋值后行多因素Logistic回归分析得出年龄、既往VTE病史、2型糖尿病、心血管疾病、高脂血症、手术时间、感染、术后制动时间、静脉穿刺次数与结直肠癌根治术后并发静脉血栓栓塞有回归关系。 结论 结直肠癌术后易并发静脉血栓栓塞,对于年龄较大、既往有VTE病史同时合并基础内科疾病的患者术中应尽量缩短手术时间,术后注意预防感染、加强活动、降低静脉穿刺次数,预防术后静脉血栓栓塞的形成。     

结直肠癌肝转移的多因素分析

目的 探讨结直肠癌肝转移的相关因素。方法 收集结直肠癌病例1312例,建立数据库。选择性别,年龄,血型,病程,首发症状,肿瘤大小,组织类型,肠壁侵袭,淋巴结转移等临床因素。用Logistic回归（spss10.0统计软件）进行单因素和多因素分析。并对有意义的指标进行相关分析。结果 单因素分析显示,性别,病程,肿瘤大体类型,组织类型,病理分级,肠壁侵袭和淋巴结转移与肝转移有关。多因素分析显示,仅性别,肠壁侵袭和淋巴结转移与肝转移有关。结直肠癌肝转移男女性别比为1.9:1。肝转移发生与肿瘤侵袭肠壁的层次呈正相关（r=0.926,P=0.024)。肝转移发生与淋巴结转移距离的远近无关（r=0.748,P=0.252)。结论 结直肠癌肝转移的相关因素主要有性别,肿瘤侵袭深度和淋巴结转移,男性结直肠癌患者更易发生肝转移,肿瘤侵袭肠壁越深,发生肝转移的危险越大,年龄,血型,病程,首发症状,肿瘤部位,肿瘤大小,术前合并症,并发病与肝转移无关。     

Colorectal Cancer and Precancerous Lesions Associated with Ulcerative Colitis in Thailand

Background: Ulcerative colitis(UC) is important risk factor of colorectal cancer. Many evidences from western countries confirmed this relationship but limited studies were reported in ASEAN. This study was aimed to investigate prevalence, clinical presentations, endoscopic findings, histopathology, disease progression and risk for colorectal cancer(CRC) of UC patients in Thailand. Methods: We conducted a retrospective cohort study using computer data base from Thammasat University Hospital, Pathumthani, Thailand between September 2011 and December 2015, follow-up through May 2016. Diagnosis of UC was confirmed by histopathology and whole clinical course. Results: We identified 6,082 patients who diagnosed with colitis during the study period. Of whom, only 22 patients(<1%) was confirmed of UC. Male to female ratio was 13:9 (mean age of 47.2 years). Clinical presentations were bloody diarrhea in 86.4%, watery diarrhea in 31.8% and abdominal pain in 59.1%. According to Montreal classification, disease extensions were ulcerative proctitis in 22.7%, distal UC in 50%, and pancolitis in 27.3%. Disease grading was mild in 31.8%, moderate in 9.1%, and severe in 59.1%. The prevalence of precancerous lesions were 2/22 patients(9.1%). There was no definite invasive colorectal cancer patient during study period. However, history of malnutrition was significantly higher in patients with dysplasia than those without dysplastic lesions(50%vs.0%, P-value=0.045). There was no difference in duration and disease extension between 2 groups. Interestingly, subgroup analysis demonstrated that pancolitis was significantly more common in female than male(55.6%vs.7.7%,P-value=0.02,OR=15.0, 95%CI=1.3-169.9). Furthermore, patients’ age> 35 years had significantly more severe colitis than younger group (81.25%vs.0%, P-value=0.0006) Conclusions: Although UC is rare disease in ASEAN, precancerous lesions for CRC were not uncommon. UC with pancolitis was common in female whereas severe colitis was common in elderly patients. Proper screening program and careful surveillance for precancerous lesions in patients at risk might be appropriate approach for early detection and improvement the treatment outcome.     

Risk Factors for Colorectal Cancer in Thailand

Background: Colorectal cancer (CRC) is one of the most common cancers worldwide. This study aimed toinvestigate the risk factors for colorectal cancer in the Thai population. Materials and Methods: A cohort studywas carried out in Khon Kaen, Thailand, including 71 cases of histologically confirmed CRC patients among 19,861participants, aged 30-69 years, who were recruited for a cohort study during the period 1990-2001. Participantswere followed-up until 31 December, 2013. To identify factors associated with the incidence of colorectal cancer,hazard ratios were evaluated using Cox proportional hazard regression. Results: No environmental variablescould be shown to be significantly related to the risk of CRC. Although in our sample, CRC was more prevalentamong males, ex-smokers, and those who drank alcohol beverages ≥ 50 gram/day, but we could not demonstratesignificantly associations (HRmale= 1.67, 95% CI, 0.80-3.49, HR ex-smokers = 1.34, 95% CI, 0.52-3.46, andHRalc≥ 50 = 1.08, 95% CI, 0.43-2.71). Individuals within the sample with a family history of cancer, workinghour >8 hours per day, and current-smokers appeared to have decrease risk of CRC, but again these relationshipcould not be shown to be significantly associated (HRfam cancer= 0.96, 95% CI, 0.85-1.09, HRwork>8= 0.84,95% CI, 0.36-1.93, and HRcurrent-smoker = 0.51, 95% CI, 0.18-1.38). Conclusions: We found no evidence ofenvironmental factors effecting the risk of CRC. There is a need for further research to determine why factorsidentified risk in other populations appear to not be associated with CRC risk in Thais.     

河南省林州市食管鳞癌及癌前病变的影响因素研究

[目的]探讨河南省林州市食管鳞癌及癌前病变的影响因素。[方法]按照性别、年龄进行1∶1∶1匹配的原则,选取2019年5~10月在林州市食管癌医院就诊的新发食管鳞癌患者、新发中重度食管鳞状上皮异型增生患者和正常对照匹配成33个区组作为研究对象。对入组的研究对象进行问卷调查,收集其人口学、生活方式等信息,采用多元有序Logistic回归对食管鳞癌及癌前病变的影响因素进行统计学分析。[结果]单因素分析结果显示,教育程度,饮用水来源,吸烟,饮酒,饮茶,食用西兰花、大蒜、酸菜、烟熏制品,劳动强度,消化道疾病史,食管癌家族史与食管鳞癌及癌前病变发生有关(P<0.05)。多元有序Logistic回归结果显示,教育程度(小学:OR=2.128,95%CI:1.116~3.187;中学及以上:OR=1.960,95%CI:1.080~2.759),饮用浅层地下水、井水(OR=3.595,95%CI:1.051~7.130),现在吸烟(OR=2.027,95%CI:1.435~5.193),经常食用酸菜(OR=2.520,95%CI:1.030~4.498),经常食用烟熏制品(OR=1.312,95%CI:1.089~1.739),有消化道疾病史(OR=2.277,95%CI:1.038~2.828)是食管鳞癌及癌前病变的独立危险因素,而经常食用西兰花(OR=0.520,95%CI:0.031~0.855)是独立保护因素。[结论]在林州市,生活方式、饮食习惯和消化道病史均可影响食管鳞癌及癌前病变的发生,有其地域特点,应针对相关影响因素采取相应的预防措施。     

Insights Into the Relationship Between Gut Microbiota and Colorectal Cancer

Purpose of review

There is growing evidence to suggest that gut microbiota plays an important role in colorectal carcinogenesis. Western diet is associated with gut microbial dysbiosis, which leads to inflammation, oxidative stress, and genotoxic effects, all common risk factors for colorectal cancer.

Recent findings

Fusobacterium nucleatum, Helicobacter pylori, Bacteroides fragilis, Escherichia coli, and Streptococcus bovis are the main bacterial species associated with colorectal carcinogenesis. Gut microbiota transforms both diet- (meat, processed meat products, fat) and host (bile acids)-derived precursors into carcinogens and further interferes with anti-cancer drug metabolism, chemotherapy efficacy, and drug-induced toxicity. Nutritional interventions, as well as the administration of beneficial bacteria (probiotics), dietary fiber (including prebiotics) supplements, and synbiotics (probiotic + prebiotic), may reduce the risk of colorectal cancer and side effects of anti-cancer therapy.

Summary

Current evidence suggests gut microbiota may predispose or protect against colorectal cancer. Restoring gut microbial dysbiosis is an emerging nutritional and clinical target in oncology.

     

Discrimination between Precancerous Gastric Lesions and Gastritis Using a Gastric Cancer Risk Stratification Model

Background: Seropositivity to certain Helicobacter pylori proteins may affect development of gastric lesions that could become cancerous. Previously, we developed a model of gastric cancer risk including gender, age, HP0305 sero-positivity, HP1564 sero-positivity, UreA antibody titer and serologically defined chronic atrophic gastritis (termed: “Lasso model”). Methods: We evaluated the Lasso model’s ability to discriminate individuals with precancerous gastric lesions (n=320) from individuals with superficial or mild atrophic gastritis (n=226) in Linqu County, China, a population at high risk for gastric cancer. We also compared its performance to the ABC Method, a gastric cancer risk stratification tool currently used in East Asia. Results: For distinguishing precancerous lesions from those with gastritis, the receiver operating characteristic curve had an area under the curve (AUC) of 73.41% (95% CI: 69.10%, 77.71%) and, at Youden’s Index, a sensitivity of 78.44% (59.38%, 82.50%) and specificity of 64.72% (95% CI: 58.85%, 81.42%). Positive predictive value (PPV) was 75.38% (72.78%, 82.51%). Specificity, AUC and PPV were significantly greater (p < 0.05) than those of the ABC Method. When specificity was held constant, the Lasso model had greater sensitivity, PPV and negative predictive value (NPV) than the ABC Method. However, adjusting the ABC Method for age and gender negated the Lasso model’s significant improvement in AUC. Conclusions: The Lasso model for gastric cancer risk prediction can classify precancerous lesions with significantly greater AUC than the ABC Method and, at constant specificity, with greater sensitivity, PPV and NPV. However, adding age and gender to the ABC Method, as included in the Lasso model, substantially improved its performance and negated the Lasso model’s advantage.     

结直肠癌临床病理分期与预后的关系

结直肠癌的预后受诸多因素的影响,其中TNM分期是最为重要的因素。TNM分期的提出是根据肿瘤发展的生物学规律总结出来的,而大宗的临床统计分析数据促成了TNM分期的不断完善和更新。文章就新近的几个大宗临床荟萃分析结果作一综述,阐述结直肠癌TNM分期与预后的关系。     

肥胖、糖尿病和高血压与子宫内膜癌前病变和癌的相关性分析

[目的]分析绝经前妇女子宫内膜发生恶变的相关危险因素。[方法]回顾性分析630例因阴道出血就诊并经病理证实绝经前子宫内膜病变患者的临床资料,比较分析良性病变组（595例）和恶性病变组（35例）患者的临床特征以及子宫内膜恶变的相关危险因素。恶性病变相关高危因素分析采用Logistic多元回归分析。[结果]调整年龄、子宫内膜厚度因素后,肥胖（RK=2．938,95％CI：1．060～8．142）、糖尿病（RR=9．945,95％CI：3．297—29．997）患子宫内膜癌前病变,癌恶性病变的风险增加。且有统计学差异：高血压患子宫内膜癌前病变／癌恶性病变的风险是无高血压患者的1．752倍（95％CI：0．903～7．831）,无统计学差异。[结论]肥胖、糖尿病与子宫内膜癌密切相关。因此,若能尽早改变生活方式,如合理饮食、增加活动量则有可能在很大程度上预防子宫内膜癌的发生。     

早期胃癌及癌前病变的血清蛋白质谱检测和分析

[目的]在血清中寻找早期胃癌及癌前病变相关的标志物,初步探讨其临床意义。[方法]收集浙江省肿瘤医院经病理证实的血清标本279例,其中早期胃癌100例,胃上皮内瘤变38例,萎缩性胃炎41例及正常对照100例。采用弱阳离子交换纳米磁珠（WCX）和表面增强激光解吸电离飞行时间质谱（SELDI-TOF-MS）技术检测获得血清多肽谱,用CiphergenProteinChip3.2.1和Biomarker Wizard软件进行分析,筛选差异峰后,采用SPSS13.0软件ROC曲线进一步评价其敏感度和特异性。[结果]与正常人群比较,早期胃癌组质荷比（m/z）为2745、3400的蛋白峰低表达,诊断敏感度分别为67.92%、66.83%,特异性分别为90.89%、81.02%;胃上皮内瘤变组m/z为2745的蛋白峰低表达,诊断敏感度和特异性分别是77.79%、82.27%;萎缩性胃炎组m/z为4800的蛋白峰低表达,诊断敏感度和特异性分别是58.52%、89.68%。[结论]m/z为2745、3400、4800的差异峰具有诊断早期胃癌及癌前病变的潜力。     

Survival Rates and Associated Factors of Colorectal Cancer Patients in Brunei Darussalam

Background: Colorectal cancer (CRC) is the third most common cancer in both men and women. In most Asian countries, both the incidence and mortality rates of CRC are gradually increasing. In Brunei Darussalam, CRC ranks first and second in lifetime risk among men and women respectively. This study aims to report the overall survival rates and associated factors of CRC in Brunei Darussalam. Methods: This is a retrospective study examining CRC data for the period 2007 to 2017 retrieved from a population based cancer registry in Brunei Darussalam. A total of 728 patients were included in the analysis. Kaplan Meier method was used to estimate survival rates. Univariate analysis using log-rank test was used to examine the differences in survival between groups. Multivariate analysis using Cox PH regression was used to estimate hazard of death and obtain significant predictors that influence CRC patients’ survival. Results: The median survival time for colorectal, colon and rectal cancer patients were 57.0, 85.8 and 40.0 months respectively. The overall 1-, 3- and 5- year survival rates for CRC patients were 78.0%, 57.7% and 49.6% respectively. In univariate analysis, age at diagnosis, ethnicity, cancer stage, tumour location and histology were found to have significant difference in CRC patients’ survival. In the Cox PH analysis, older age (≥70 years), cancer stage, ethnicity and other histological type were determined as associated factors of CRC patients’ survival. Conclusion: This study found the overall 5-year survival rate of CRC in Brunei Darussalam is similar to that in some Asian countries such as Singapore and Malaysia. However, more efforts need to be carried out in order to raise awareness of CRC and improve the survival of CRC patients.