Efremidou E I, Liratzopoulos N, Papageorgiou S M, Romanidis K, Tourlis Th, Kouklakis G, Manolas K J
First Department of Surgery, Medical School of Democritus University of Thrace, University Hospital of Alexandroupolis, Greece.
Chirurgia (Bucur). 2008 Nov-Dec;103(6):659-63.
Several studies have shown a migration in the occurrence of colorectal cancer (CRC) toward a proximal colonic location. The aim of this study was to examine the interrelationship between the anatomical distribution of CRC and gender, age at presentation, and incidence rates for the disease in the inhabitants of Thrace, Northern Greece.
A retrospective study was conducted on CRC cases diagnosed in a northern part of Greece (Evros region, 150.000 inhabitants), in the First Department of Surgery of the University General Hospital of Thrace, between 1982 and 1997. Two time periods were compared (1982-1989 and 1990-1997), at which age at diagnosis (28-88 years), gender, the incidence and subsite location of CRC were identified in the patients. Tumors were classified into right-sided cancers (from the cecum to and including the splenic flexure), left-sided cancers (located in the descending and the sigmoid colon), and rectal cancers (rectal lesions). The chi-square test and Fischer's exact test were used to compare the data.
During the entire study period (1982-1997), 143 cases of CRC were identified in our department. This cohort comprised 71 males and 72 females, with mean ages of 66 years and 64.7 years, respectively. The population remained almost stable during this time period. The incidence of CRC was significantly higher in the latter part of the study (1990-1997 compared to 1982-1989) for both genders (p < 0.001), with this increase being higher among the female patients with CRC (by 17.32%, p = 0.474). The analysis also revealed that the disease occurred at a significantly higher frequency at a later age (p = 0.002), especially in patients with RC (p = 0.001). A proximal migration of CRC was observed in the latter part of the study (p = 0.495), with the frequency of right-sided cancers increasing significantly among the females (by 119%, p = 0.025).
The incidence of CRC has increased in our region. In addition, a proximal migration of tumors over time was identified, especially in older and female individuals, which was linked to a decrease in the incidence of left colon cancer. These findings have important implications for the choice of CRC screening strategies.
多项研究表明，结直肠癌（CRC）的发病部位有向近端结肠转移的趋势。本研究的目的是探讨希腊北部色雷斯地区居民结直肠癌的解剖分布与性别、就诊年龄以及发病率之间的相互关系。
对1982年至1997年间在希腊北部（埃夫罗斯地区，15万居民）色雷斯大学总医院第一外科诊断的结直肠癌病例进行回顾性研究。比较了两个时间段（1982 - 1989年和1990 - 1997年），确定了患者的诊断年龄（28 - 88岁）、性别、结直肠癌的发病率和亚部位。肿瘤分为右侧癌（从盲肠至脾曲，包括脾曲）、左侧癌（位于降结肠和乙状结肠）和直肠癌（直肠病变）。采用卡方检验和费舍尔精确检验对数据进行比较。
在整个研究期间（1982 - 1997年），我们科室共确诊143例结直肠癌病例。该队列包括71名男性和72名女性，平均年龄分别为66岁和64.7岁。在此期间，人口基本保持稳定。两个时间段相比，研究后期（1990 - 1997年与1982 - 1989年）两性的结直肠癌发病率均显著升高（p < 0.001），女性结直肠癌患者的发病率升高更为明显（升高17.32%，p = 0.474）。分析还显示，该疾病在较晚年龄发病的频率显著更高（p = 0.002），尤其是右侧结肠癌患者（p = 0.001）。研究后期观察到结直肠癌有向近端转移的趋势（p = 0.495），女性右侧结肠癌的发病率显著增加（增加119%，p = 0.025）。
我们地区结直肠癌的发病率有所上升。此外，随着时间的推移，肿瘤出现向近端转移的趋势，尤其是在老年和女性个体中，这与左结肠癌发病率的下降有关。这些发现对结直肠癌筛查策略的选择具有重要意义。
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