Department of Gastroenterology, Lanzhou General Hospital of Chinese People's Liberation Army, Lanzhou, Gansu Province, China.
J Dig Dis. 2012 Oct;13(10):517-24. doi: 10.1111/j.1751-2980.2012.00626.x.
To investigate the diagnostic status of colorectal cancer (CRC) and the influence of early diagnosis and cancer stage in a tertiary care hospital in China.
Face-to-face interviews were conducted in 364 consecutive CRC patients who had never participated in CRC screening. Initial symptoms, diagnosis and treatment delay were determined using a questionnaire. Factors influencing diagnostic status were analyzed using univariate analysis and logistic regression model.
A total of 307 patients were enrolled, in which 128 were with colon cancer and 179 with rectal cancer. The duration of diagnosis delay was significant longer than that of treatment delay. Unlike rectal cancer, colon cancer was likely to be treated at an advanced stage with a short interval between symptom onset and treatment. Colon cancer patients with a history of biliary tract or gallbladder stones, aged ≥ 50 years and with abdominal mass or intestinal obstruction as the initial symptom were diagnosed and treated much earlier. In rectal cancer, women and non-smokers were diagnosed and treated quickly. Factors correlated with early cancer stage were found in colon cancer, including bloody stool as the initial symptom (OR = 2.63, 95% CI 1.08-6.25, P = 0.034) and a history of appendectomy (OR = 4.00, 95% CI 1.15-14.29, P = 0.029).
The factors contributing to early cancer detection were identified but their clinical value is limited. Diagnosis by symptoms suggesting CRC needs to be improved and CRC screening should be vigorously promoted.
调查中国一家三级医院结直肠癌（CRC）的诊断现状，以及早期诊断和癌症分期对诊断的影响。
对 364 例从未参加过 CRC 筛查的连续 CRC 患者进行面对面访谈。使用问卷确定首发症状、诊断和治疗延迟。使用单因素分析和逻辑回归模型分析影响诊断状况的因素。
共纳入 307 例患者，其中结肠直肠癌 128 例，直肠 179 例。诊断延迟时间明显长于治疗延迟时间。与直肠 癌不同，结肠癌更有可能在症状出现后很快进入晚期阶段，并在症状出现与治疗之间间隔较短。有胆道或胆囊结石史、年龄≥50 岁且以腹部肿块或肠梗阻为首发症状的结肠癌患者更早得到诊断和治疗。在直肠癌中，女性和不吸烟者的诊断和治疗速度较快。在结肠癌中发现与早期癌症阶段相关的因素包括便血作为首发症状（OR=2.63，95%CI 1.08-6.25，P=0.034）和阑尾切除术史（OR=4.00，95%CI 1.15-14.29，P=0.029）。
确定了有助于早期发现癌症的因素，但它们的临床价值有限。需要改进对提示 CRC 的症状的诊断，大力推广 CRC 筛查。
