Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Almirante 28, 28004, Madrid, Spain.
Department of Public Health and Maternal and Child Health, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain.
BMC Cancer. 2018 Apr 10;18(1):402. doi: 10.1186/s12885-018-4265-1.
Cancer registry data show that survival of colorectal cancer (CRC) in the United Kingdom is poor compared with other European countries and the United States, yet these data sources lack information on patient comorbidities and medication use, which could help explain these differences.
Among individuals aged 40-89 years in The Health Improvement Network (2000-2014), we identified first ever cases of CRC and calculated incidence rates with 95% confidence intervals (CIs). For CRC cases and non-cases in two separate calendar years (2002 and 2014), we evaluated patient demographics, lifestyle factors, comorbidities and medication use and bowel screening.
The incidence of CRC remained relatively constant across the study period; incidence rates per 10,000 person-years (95% CIs) were 9.27 (8.59-1.01) in 2000, 10.65 (10.15-11.18) in 2007 and 8.37 (7.93-8.83) in 2014. Incidence rates per 10,000 person-years were higher in men than women at 11.44 (95% CI: 10.35-12.66) vs. 7.40 (95% CI: 6.59-8.32) in 2000, and 9.39 (95% CI: 8.74-10.10) vs. 7.38 (95% CI: 6.81-8.00) in 2014. An increase was seen in the proportion of CRC cases diagnosed at age < 60 years. In 2002, 3.5% of CRC cases were diagnosed at age 40-49 compared with 5.1% in 2014 (p = 0.064). Similarly, in 2002, 12.5% were diagnosed at age 50-59 years compared with 16.2% in 2014 (p = 0.002). Between 2002 and 2014, previous bowel screening increased in both CRC cases (+ 10.6%) and non-cases (+ 9.7%)(p < 0.001 for both groups). Greater rises in the following were seen among CRC cases compared with non-cases: diabetes (+ 9.3% vs. + 3.3%; p < 0.001 for both), obesity (+ 14.5% vs. + 10.1%; p < 0.001 for both), hypertension (+ 8.3% vs. + 3.6%; p < 0.001 for both), atrial fibrillation (+ 2.6% [p < 0.01] vs. + 0.3% [p < 0.001]), and use of proton pump inhibitors (+ 11.5% vs. + 9.0%), anti-hypertensives (+ 9.9% vs. + 1.4%) and warfarin (+ 3.2% vs. + 0.4%); p < 0.001 for CRC cases and non-cases with respect to each medication.
CRC incidence has remained relatively stable in the UK over the last decade. The increased prevalence of some comorbidities and medications among CRC cases should be considered when evaluating patterns in CRC survival.
癌症登记数据显示，与其他欧洲国家和美国相比，英国的结直肠癌（CRC）患者生存率较差，然而这些数据源缺乏关于患者合并症和药物使用的信息，这些信息可能有助于解释这些差异。
在 The Health Improvement Network（2000-2014 年）中，我们确定了 40-89 岁人群中首次出现的 CRC 病例，并计算了发病率，置信区间为 95%。对于 2002 年和 2014 年两个不同的日历年内的 CRC 病例和非病例，我们评估了患者的人口统计学特征、生活方式因素、合并症和药物使用以及肠道筛查情况。
研究期间 CRC 的发病率保持相对稳定；每 10000 人年的发病率（95%CI）分别为 2000 年的 9.27（8.59-1.01）、2007 年的 10.65（10.15-11.18）和 2014 年的 8.37（7.93-8.83）。男性的发病率高于女性，2000 年为 11.44（95%CI：10.35-12.66），2014 年为 9.39（95%CI：8.74-10.10）；女性的发病率分别为 7.40（95%CI：6.59-8.32）和 7.38（95%CI：6.81-8.00）。诊断年龄小于 60 岁的 CRC 病例比例有所增加。2002 年，40-49 岁诊断为 CRC 的病例比例为 3.5%，而 2014 年为 5.1%（p=0.064）。同样，2002 年 50-59 岁诊断为 CRC 的病例比例为 12.5%，而 2014 年为 16.2%（p=0.002）。2002 年至 2014 年间，CRC 病例和非病例的既往肠道筛查均有所增加（CRC 病例增加了+10.6%，非病例增加了+9.7%）（两组均 p<0.001）。CRC 病例中观察到以下疾病的发病率上升幅度大于非病例：糖尿病（+9.3% vs. +3.3%；两组均 p<0.001）、肥胖（+14.5% vs. +10.1%；两组均 p<0.001）、高血压（+8.3% vs. +3.6%；两组均 p<0.001）、心房颤动（+2.6% [p<0.01] vs. +0.3% [p<0.001]）和质子泵抑制剂的使用（+11.5% vs. +9.0%）、抗高血压药物（+9.9% vs. +1.4%）和华法林（+3.2% vs. +0.4%）；CRC 病例和非病例在每种药物的使用方面均有显著差异（p<0.001）。
在过去十年中，英国的 CRC 发病率保持相对稳定。在评估 CRC 生存率的模式时，应考虑 CRC 病例中一些合并症和药物的患病率增加的情况。
