Department of Surgery, George Eliot Hospital, Nuneaton, United Kingdom.
Surgeon. 2011 Apr;9(2):78-82. doi: 10.1016/j.surge.2010.07.012. Epub 2010 Aug 26.
To determine detection strategies for colorectal cancer (CRC) and to analyse subsequent survival from a 2 week wait (2WW) service.
Retrospective analysis of 2WW and hospital CRC databases from January 2006 to July 2009. Survival was assessed using Kaplan Meier survival curves and Cox's proportional hazard models. Proximal cancers were those proximal to and including the splenic flexure.
From 1725 patients seen in a 2WW clinic, 108 were identified with CRC. Median follow-up in survivors was 514 days (interquartile range 160-788 days). Of 23 patients investigated for iron deficient anaemia and/or abdominal mass, 78% (18) were found to have proximal cancers. Of 85 patients with symptoms of change in bowel habit, rectal bleeding or abdominal pain, 15% (13) were found to have proximal cancers. Age, haemoglobin and mean corpuscular volumes between these 13 patients and the 72 distal cancers in this group were not significantly different. Multivariable analysis showed that survival was lower for those presenting with proximal cancers (hazard ratio 2.912, 95% confidence interval 1.361-6.227, p=0.006) and for those with increasing Dukes stage (p<0.001).
Flexible sigmoidoscopy would have missed 15% of cancers in those presenting with symptoms alone. Patients with proximal tumours had a worse prognosis. Further research is needed to identify those presenting with symptoms alone who are at high risk of having proximal tumours and thus requiring whole colonic imaging.
确定结直肠癌（CRC）的检测策略，并分析 2 周等待（2WW）服务后的生存情况。
回顾性分析 2006 年 1 月至 2009 年 7 月的 2WW 和医院 CRC 数据库。使用 Kaplan-Meier 生存曲线和 Cox 比例风险模型评估生存情况。近端癌是指包括脾曲在内的近端癌。
在 2WW 诊所就诊的 1725 例患者中，发现 108 例患有 CRC。幸存者的中位随访时间为 514 天（四分位距 160-788 天）。在因缺铁性贫血和/或腹部肿块接受检查的 23 例患者中，78%（18 例）发现为近端癌。在 85 例有排便习惯改变、直肠出血或腹痛症状的患者中，发现 15%（13 例）为近端癌。这些患者与本组 72 例远端癌患者的年龄、血红蛋白和平均红细胞体积无显著差异。多变量分析显示，近端癌患者的生存率较低（风险比 2.912，95%置信区间 1.361-6.227，p=0.006），且 Dukes 分期越高（p<0.001）。
对于仅出现症状的患者，软性乙状结肠镜检查将漏诊 15%的癌症。近端肿瘤患者预后较差。需要进一步研究以确定那些仅出现症状的患者中哪些是患有近端肿瘤且需要全结肠成像的高危人群。
