Department of Colorectal Surgery, Bristol Royal Infirmary, Bristol, UK.
Department of Gastroenterology, Bristol Royal Infirmary, Bristol, UK.
Colorectal Dis. 2023 Sep;25(9):1771-1782. doi: 10.1111/codi.16666. Epub 2023 Aug 8.
Proximal and distal colorectal cancers (CRCs) exhibit different clinical, molecular and biological patterns. The aim of this study was to determine temporal trends in the age-standardized incidence rates (ASIRs) of proximal and distal CRC following the introduction of the English Bowel Cancer Screening Programme (BCSP) in 2006.
The National Cancer Registration and Analysis Service database was used to identify incident cases of CRC among adults of screening age (60-74 years) between 2001 and 2017. ASIRs were calculated using the European Standard Population 2013 and incidence trends analysed by anatomical subsite (proximal, caecum to descending colon; distal, sigmoid to rectum), sex and Index of Multiple Deprivation (IMD) quintile using Joinpoint regression software.
Between 2001 and 2017, 541 515 incident cases of CRC were diagnosed [236 167 proximal (43.6%) and 305 348 distal (56.4%)]. A marginal reduction in the proximal ASIR was noted from 2008 [annual percentage change (APC) -1.4% (95% CI -2.0% to -0.9%)] compared with a greater reduction in distal ASIR from 2011 to 2014 [APC -6.6% (95% CI -11.5% to -1.5%)] which plateaued thereafter [APC -0.5% (95% CI -3.2% to 2.2%)]. Incidence rates decreased more rapidly in men than women. Adults in IMD quintiles 4-5 experienced the greatest reduction in distal tumours [APC -3.5% (95% CI -4.3% to -2.7%)].
Following the introduction of the English BCSP, the incidence of CRC has subsequently reduced among adults of screening age, with this trend being most pronounced in distal tumours and in men. There is also evidence of a reduction in the deprivation gap for distal tumour incidence. Strategies to improve the detection of proximal tumours are warranted.
近端和远端结直肠癌（CRC）表现出不同的临床、分子和生物学特征。本研究旨在确定自 2006 年英国结直肠癌筛查计划（BCSP）引入以来，近端和远端 CRC 的年龄标准化发病率（ASIR）的时间趋势。
使用国家癌症登记和分析服务数据库，在 2001 年至 2017 年期间，确定筛查年龄（60-74 岁）成年人的 CRC 新发病例。使用 2013 年欧洲标准人群计算 ASIR，并使用 Joinpoint 回归软件分析解剖部位（近端，盲肠至降结肠；远端，乙状结肠至直肠）、性别和多因素贫困指数（IMD）五分位数的发病率趋势。
2001 年至 2017 年间，诊断出 541515 例 CRC 新发病例[近端 236167 例（43.6%），远端 305348 例（56.4%）]。与 2011 年至 2014 年远端 ASIR 下降 6.6%（95%CI-11.5%至-1.5%）相比，2008 年近端 ASIR 略有下降（APC-1.4%（95%CI-2.0%至-0.9%）），此后趋于平稳（APC-0.5%（95%CI-3.2%至 2.2%））。男性的发病率下降速度快于女性。IMD 五分位数 4-5 组的成年人远端肿瘤的降幅最大[APC-3.5%（95%CI-4.3%至-2.7%）]。
英国 BCSP 引入后，筛查年龄组成年人的 CRC 发病率随后下降，远端肿瘤和男性的发病率下降趋势最为明显。远端肿瘤发病率的贫困差距也有所缩小。需要制定提高近端肿瘤检出率的策略。
