Masson S, Chinn D J, Tabaqchali M A, Waddup G, Dwarakanath A D
Department of Gastroenterology, University Hospital of North Tees, Stockton on Tees, UK.
Colorectal Dis. 2007 Oct;9(8):736-9. doi: 10.1111/j.1463-1318.2006.01200.x.
Current efforts to improve the outcome from colorectal cancer aim to shorten the delay between referral and diagnosis. Investigation of iron-deficiency anaemia has a high yield for the diagnosis of gastrointestinal malignancy and its presence is included in current referral guidelines. We explored the relationship between anaemia and colorectal cancer.
We reviewed hospital and laboratory database records of patients diagnosed with colorectal cancer between January 2003 and June 2004. The site of colorectal cancer was correlated with the presence of anaemia at the time of referral. Anaemia was defined according to local practice (Hb < 12.0 g/dl in females and <13.0 g/dl in males), compared with the threshold recommended in current national referral guidelines (Hb < 10 g/dl in females and <11 g/dl in males).
Over 18 months, 143 patients were diagnosed with colorectal cancer. Anaemia was present in 48% of males and 50% of females using local practice and 24% of males and 16% of females using national referral guidelines. Those with right-sided and non-rectal cancers were significantly more likely to be anaemic than those with left-sided and rectal cancers, respectively.
In approximately half of cases the diagnosis of colorectal cancer is not associated with anaemia. Anaemia is more common with proximal lesions but this is not a consistent finding. The current threshold for anaemia at which national guidelines suggest referral also appears to be insensitive.
目前改善结直肠癌治疗效果的努力旨在缩短转诊与诊断之间的延迟。缺铁性贫血检查对胃肠道恶性肿瘤的诊断具有较高的阳性率，且其存在已被纳入当前的转诊指南。我们探讨了贫血与结直肠癌之间的关系。
我们回顾了2003年1月至2004年6月期间被诊断为结直肠癌的患者的医院和实验室数据库记录。将结直肠癌的发病部位与转诊时贫血的存在情况进行关联。贫血根据当地的标准定义（女性血红蛋白<12.0 g/dl，男性血红蛋白<13.0 g/dl），并与当前国家转诊指南中推荐的阈值（女性血红蛋白<10 g/dl，男性血红蛋白<11 g/dl）进行比较。
在18个月的时间里，有143例患者被诊断为结直肠癌。按照当地标准，48%的男性和50%的女性存在贫血；按照国家转诊指南，24%的男性和16%的女性存在贫血。右侧结肠癌和非直肠癌患者比左侧结肠癌和直肠癌患者分别更易出现贫血。
在大约一半的病例中，结直肠癌的诊断与贫血无关。近端病变患者中贫血更为常见，但这并非是一个一致的发现。国家指南建议转诊时的当前贫血阈值似乎也不敏感。
