Clinical characteristics, medical service utilization, and expenditure for colorectal cancer in China, 2005 to 2014: Overall design and results from a multicenter retrospective epidemiologic survey
Clinical characteristics, medical service utilization, and expenditure for colorectal cancer in China, 2005 to 2014: Overall design and results from a multicenter retrospective epidemiologic survey
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作者：
Shi, Ju-Fang;Wang, Le;He, Jie
背景结直肠癌（Colorectal cancer，CRC）是我国第三大常见恶性肿瘤，但其临床流行病学资料较少。与社会人口学特征，诊断技术的使用，治疗采用，和支出的数据提取个人medical records.Results在整个队列的8465例患者，平均+/- SD诊断年龄为59.3 +/- 12.8岁，57.2%是男性，58.7%有直肠癌。平均而言，14.4%的患者被诊断为IV期疾病，这一比例从2005年的13.5%增加到2014年的20.5%（趋势P值<0.05）。对于诊断技术，沿着较少使用X射线（平均81.6%;从90.0%降至65.7%），计算机断层扫描的使用有所增加（平均70.4%;从4.5%增加到90.5%）和磁共振成像（平均8.8%;从0.1%增加到20.4%）在2005年至2014年的研究期间。在治疗方面，单纯手术最常见（平均50.1%），但在2005年至2014年期间，其使用率从51.3%下降至39.8%;其他治疗方法的使用也同时增加，如单纯化疗（平均4.1%;从4.1%增加至11.9%）。平均每例患者的医疗费用为66，291元（2014年值），从47，259元增加到86，709元。这项研究清楚地说明了诊断和治疗选择的变化以及支出的增加。再加上最近引入的筛查措施，这些数据提供了对随时间变化的理解，并可能成为未来中国CRC干预措施相关评估的基准。
BACKGROUND Colorectal cancer (CRC) is the third most common cancer in China, however, publicly available, descriptive information on the clinical epidemiology of CRC is limited.METHODS Patients diagnosed with primary CRC during 2005 through 2014 were sampled from 13 tertiary hospitals in 9 provinces across China. Data related to sociodemographic characteristics, the use of diagnostic technology, treatment adoption, and expenditure were extracted from individual medical records.RESULTS In the full cohort of 8465 patients, the mean +/- SD age at diagnosis was 59.3 +/- 12.8 years, 57.2% were men, and 58.7% had rectal cancer. On average, 14.4% of patients were diagnosed with stage IV disease, and this proportion increased from 13.5% in 2005 to 20.5% in 2014 (P value for trend < .05). For diagnostic techniques, along with less use of x-rays (average, 81.6%; decreased from 90.0% to 65.7%), there were increases in the use of computed tomography (average, 70.4%; increased from 4.5% to 90.5%) and magnetic resonance imaging (average, 8.8%; increased from 0.1% to 20.4%) over the study period from 2005 to 2014. With regard to treatment, surgery alone was the most common (average, 50.1%), but its use decreased from 51.3% to 39.8% during 2005 through 2014; and the use of other treatments increased simultaneously, such as chemotherapy alone (average, 4.1%; increased from 4.1% to 11.9%). The average medical expenditure per patient was 66,291 Chinese Yuan (2014 value) and increased from 47,259 to 86,709 Chinese Yuan.CONCLUSIONS The increasing proportion of late-stage diagnoses presents a challenge for CRC control in China. Changes in diagnostic and treatment options and increased expenditures are clearly illustrated in this study. Coupled with the recent introduction of screening initiatives, these data provide an understanding of changes over time and may form a benchmark for future related evaluations of CRC interventions in China.