近端肿瘤与结肠癌患者死亡率升高相关。
Proximal tumors are associated with greater mortality in colon cancer.
机构信息
Department of Medicine, California Pacific Medical Center, 2351 Clay Street, Suite 380, San Francisco, CA 94115, USA.
出版信息
J Gen Intern Med. 2010 Nov;25(11):1157-63. doi: 10.1007/s11606-010-1460-4.
BACKGROUND
Colon cancer is the third leading cause of death from cancer in the United States. Recent studies report on increasing proportions of proximal cancers. The etiology behind this epidemiological trend is unclear, and its implication on survival outcomes is unknown. Further analysis of the impact of anatomic site of disease among a large multiethnic population will help facilitate research and education to improve colon cancer screening and treatment.
OBJECTIVE
To investigate the association between proximal tumor location and survival in patients with colon cancer.
DESIGN AND PARTICIPANTS
A large retrospective cohort study in the US utilizing the Surveillance, Epidemiology, and End Results (SEER) cancer registry analyzed survival outcomes of patients with colon cancer. Multivariable logistic regression analyses investigated sex-specific, race/ethnicity-specific, and anatomic site-specific disparities in survival.
MAIN MEASURES
Five-year survival outcomes from colon cancer.
RESULTS
Our study demonstrated significant disparities in survival by sex, race/ethnicity, and anatomic site. Across all time periods and among most cohorts, patients with proximal cancers had significantly worse survival outcomes. When compared to distal cancers, patients with proximal cancers were 13% less likely to survive 5 years (OR 0.87; 95% CI, 0.82-0.91). When compared to non-Hispanic whites, blacks were 30% less likely to survive 5 years (OR 0.70; 95% CI, 0.68-0.73). Stage-specific multivariable regression analysis of localized cancers demonstrated similar findings.
CONCLUSIONS
Significant race-specific, sex-specific, and anatomic site-specific disparities in colon cancer survival exist. Proximal cancers are associated with worse survival odds. These disparities may reflect differences in the genotype and phenotype of colon cancer among these groups. A modified risk assessment tool that incorporates these variations may be more effective in the early detection and treatment of colon cancer.
背景
在美国，结肠癌是癌症死亡的第三大主要原因。最近的研究报告称，近端结肠癌的比例在增加。这种流行病学趋势的病因尚不清楚，其对生存结果的影响也未知。在一个多民族人群中进一步分析疾病解剖部位的影响，将有助于促进研究和教育，以改善结肠癌的筛查和治疗。
目的
研究结肠癌患者近端肿瘤位置与生存的关系。
设计和参与者
本研究在美国进行了一项大型回顾性队列研究，利用监测、流行病学和最终结果（SEER）癌症登记处分析了结肠癌患者的生存结果。多变量逻辑回归分析调查了性别特异性、种族/族裔特异性和解剖部位特异性生存差异。
主要措施
结肠癌的 5 年生存结果。
结果
我们的研究表明，性别、种族/族裔和解剖部位的生存存在显著差异。在所有时间段和大多数队列中，近端癌患者的生存结果明显较差。与远端癌症相比，近端癌症患者 5 年生存率降低 13%（OR 0.87；95%CI，0.82-0.91）。与非西班牙裔白人相比，黑人 5 年生存率降低 30%（OR 0.70；95%CI，0.68-0.73）。局部癌症的特定阶段多变量回归分析得出了类似的发现。
结论
结肠癌的生存存在显著的种族特异性、性别特异性和解剖部位特异性差异。近端癌症与较差的生存几率相关。这些差异可能反映了这些人群中结肠癌基因型和表型的差异。一种纳入这些变化的改良风险评估工具可能更有效地用于结肠癌的早期检测和治疗。
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