脆弱人群中结直肠癌的晚期表现。
Late presentation of colorectal cancer in a vulnerable population.
机构信息
Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, CA 94143, USA.
出版信息
Am J Gastroenterol. 2013 Apr;108(4):466-70. doi: 10.1038/ajg.2012.256.
OBJECTIVES
We examined colorectal cancer (CRC) stage at presentation and mortality in a vulnerable population compared with nationally representative data.
METHODS
CRC cases were identified from San Francisco General Hospital (SFGH) and the Surveillance Epidemiology and End Results (SEER) database.
RESULTS
Fifty-five percent of the SFGH cohort presented with advanced disease, compared with 44% of the SEER cohort. Increased risk of advanced stage at presentation at SFGH compared with SEER was most evident among blacks and Asians. There was weak evidence for worse survival at SFGH compared with SEER overall. This varied by race with poorer survival at SFGH among whites and possibly blacks but some evidence for better survival among Asians. Among CRC patients at SFGH, Asians and Hispanics had better survival than whites and blacks. At SFGH, 44% had a diagnosis of CRC within 1 year of establishing care there. Of those who had established care at SFGH for at least 1 year, only 22% had exposure to CRC screening tests.
CONCLUSIONS
These findings allow examination of CRC presentation by ethnicity in vulnerable populations and identify areas where access and utilization of CRC screening can be improved.
目的
与全国代表性数据相比，我们研究了弱势人群中结直肠癌（CRC）的就诊时分期和死亡率。
方法
CRC 病例来自旧金山总医院（SFGH）和监测、流行病学和最终结果（SEER）数据库。
结果
SFGH 队列中 55%的患者就诊时已处于晚期，而 SEER 队列中这一比例为 44%。与 SEER 相比，SFGH 中黑人及亚裔患者就诊时更易出现晚期疾病，这一风险增加的情况尤为明显。与 SEER 相比，SFGH 的总体生存情况较差，但证据强度较弱。这种情况因种族而异，白人及黑人患者在 SFGH 的生存情况较差，但亚裔患者的生存情况可能更好。在 SFGH 的 CRC 患者中，亚裔和西班牙裔的生存情况优于白人及黑人。在 SFGH，44%的患者在建立医疗服务关系后 1 年内被诊断为 CRC。在至少在 SFGH 建立医疗服务关系 1 年以上的患者中，仅有 22%接受了 CRC 筛查检测。
结论
这些发现使我们能够根据弱势群体的种族来检查 CRC 的就诊情况，并确定可以改善 CRC 筛查的获取和利用的领域。
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