Nelson R L, Dollear T, Freels S, Persky V
Department of Surgery, University of Illinois College of Medicine at Chicago, USA.
Cancer. 1997 Jul 15;80(2):193-7. doi: 10.1002/(sici)1097-0142(19970715)80:2<193::aid-cncr4>3.0.co;2-v.
Characteristics that determine the anatomic site within the colorectum where carcinoma is most likely to occur would be useful in choosing optimal modalities for cancer screening and in the study of etiology. The aim of this study was to identify any association of gender, race, or age with colorectal carcinoma in the proximal or distal colorectum.
A descriptive, population-based epidemiologic study was conducted on colorectal carcinoma (CRC) cases identified through the Illinois Tumor Registry. Among CRC patients diagnosed between 1986 and 1991, age at diagnosis (40-90 years), gender, white or African American race, and subsite of CRC location were identified. Incidence rates were determined with demographic data from the 1990 Illinois census. Logistic regression was used to identify significant subsite specific risk factors for CRC.
During the study period, 38,931 cases of CRC occurred in Illinois among whites and African Americans between the ages of 40 and 90 years. Age, race, and gender were independently significantly associated with both proximal and distal CRC risk (P < 0.0001). The greatest risk for white males was for distal CRC, followed by the risk for African American males of developing CRC in the distal colorectum. African Americans were more likely than whites to develop proximal CRC (odds ratio [OR] = 1.19), whereas whites were more likely to have distal CRC than African Americans (OR = 1.26). Regarding the development of CRC anywhere in the colorectum, male incidence rates adjusted for age and race were greater than rates for females (OR = 1.32 for proximal and 1.68 for distal).
The division of the colorectum anatomically in these analyses at the junction of the descending and sigmoid colon, and including the rectum above the anal canal with "distal" CRC, demonstrated a predominance of African Americans among those at risk for proximal colon carcinoma and a predominance of white males among those at risk for distal CRC; these predominances were clearer than in previous reports. These findings may have a role in the selection of optimal CRC screening strategies for each gender or racial group.
确定结直肠癌最可能发生的结直肠解剖部位的特征，对于选择最佳癌症筛查方式及病因学研究很有用。本研究的目的是确定性别、种族或年龄与近端或远端结直肠癌之间的任何关联。
对通过伊利诺伊肿瘤登记处识别出的结直肠癌（CRC）病例进行了一项基于人群的描述性流行病学研究。在1986年至1991年间诊断的CRC患者中，确定了诊断时的年龄（40 - 90岁）、性别、白人或非裔美国人种族以及CRC发生部位的亚部位。发病率是根据1990年伊利诺伊州人口普查的人口统计数据确定的。采用逻辑回归来确定CRC特定亚部位的显著危险因素。
在研究期间，伊利诺伊州40至90岁的白人和非裔美国人中发生了38931例CRC病例。年龄、种族和性别均与近端和远端CRC风险独立显著相关（P < 0.0001）。白人男性患远端CRC的风险最高，其次是非裔美国男性患远端结直肠癌的风险。非裔美国人比白人更易患近端CRC（优势比[OR] = 1.19），而白人比非裔美国人更易患远端CRC（OR = 1.26）。关于结直肠任何部位CRC的发生情况，经年龄和种族调整后的男性发病率高于女性（近端OR = 1.32，远端OR = 1.68）。
在这些分析中，将结直肠在降结肠和乙状结肠交界处进行解剖划分，并将肛管上方的直肠包括在“远端”CRC中，结果显示非裔美国人在近端结肠癌高危人群中占主导，白人男性在远端CRC高危人群中占主导；这些主导情况比以往报告中更明显。这些发现可能在为每个性别或种族群体选择最佳CRC筛查策略中发挥作用。
