Mengual-Ballester Mónica, Pellicer-Franco Enrique, Valero-Navarro Graciela, Soria-Aledo Victoriano, García-Marín José Andrés, Aguayo-Albasini José Luis
Digestive Surgery Department, Morales Meseguer Hospital, Avda. Marqués de los Vélez s/n, 30008, Murcia, Spain.
IMIB-Arrixaca, University of Murcia, Mare Nostrum International Excellence Campus, Murcia, Spain.
Int J Colorectal Dis. 2018 Jan;33(1):23-28. doi: 10.1007/s00384-017-2928-z. Epub 2017 Nov 14.
Diagnosis of colorectal cancer (CRC) based on clinical symptoms is usually established in its advanced stages. One strategy for reducing mortality is the early detection and removal of preneoplastic and initial neoplastic lesions, even before the first symptoms appear, by means of population-based screening campaigns. The aim of the present study is to determine whether CRC diagnosed via a screening campaign has more favourable histopathological prognostic factors than when diagnosed in the symptomatic phase.
The prospective study of all the patients undergoing programmed CRC surgery at the JM Morales Meseguer Hospital (Spain) is between 2004 and 2010. The patients were divided into two groups: one diagnosed from clinical symptoms and one through a screening campaign. The following factors were compared: tumour size; degree of tumour invasion of the wall; lymph node, perineural and lymphovascular involvement; tumour stage; and grade of differentiation.
Compared to the symptomatic group, the screen-detected patients had smaller-sized tumours (lesions of less than 5 cm in 84 vs 69.55%, p < 0.001), a lower degree of colorectal wall invasion (T0-1 in 36 vs 9.02%, p < 0.001), less lymph node involvement (N0 in 72 vs 58.76%, p > 0.05), less vascular invasion (7.20 vs 15.22%, p = 0.79) and less perineural invasion (6.4 vs 20.70%, p < 0.001). The TNM staging in the screening group was lower than in the symptomatic group (stage 0-1 in 50.40 vs 18.58%, p < 0.001).
CRC diagnosed through a population-based screening programme presents more favourable histopathological characteristics than that diagnosed from the appearance of symptoms.
基于临床症状诊断的结直肠癌（CRC）通常在疾病晚期才能确诊。降低死亡率的一种策略是通过基于人群的筛查活动，在首次症状出现之前尽早发现并切除癌前病变和早期肿瘤病变。本研究的目的是确定通过筛查活动诊断出的CRC是否比有症状阶段诊断出的CRC具有更有利的组织病理学预后因素。
对2004年至2010年间在西班牙JM莫拉莱斯·梅塞格尔医院接受计划性CRC手术的所有患者进行前瞻性研究。患者分为两组：一组通过临床症状诊断，另一组通过筛查活动诊断。比较以下因素：肿瘤大小；肿瘤侵犯肠壁的程度；淋巴结、神经周围和淋巴管受累情况；肿瘤分期；以及分化程度。
与有症状组相比，筛查发现的患者肿瘤较小（肿瘤小于5 cm的比例分别为84%和69.55%，p < 0.001），结直肠壁侵犯程度较低（T0-1期分别为36%和9.02%，p < 0.001），淋巴结受累较少（N0期分别为72%和58.76%，p > 0.05），血管侵犯较少（分别为7.20%和15.22%，p = 0.79），神经周围侵犯较少（分别为6.4%和20.70%，p < 0.001）。筛查组的TNM分期低于有症状组（0-1期分别为50.40%和18.58%，p < 0.001）。
通过基于人群的筛查计划诊断出的CRC比从症状出现时诊断出的CRC具有更有利的组织病理学特征。
