How does colorectal cancer present? Symptoms, duration, and clues to location
How does colorectal cancer present? Symptoms, duration, and clues to location
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DOI：
10.1111/j.1572-0241.1999.01454.x
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发表时间：
1999-10-01
影响因子：
9.8
通讯作者：
Evans, AT
中科院分区：
文献类型：
--
作者：
Majumdar, SR;Flecher, RH;Evans, AT
目的：大多数结直肠癌仍然存在症状，因为筛查虽然有效，但尚未广泛实施。仔细的病史和体格检查仍然是怀疑结直肠癌和安排适当调查的常用方法。因此，我们研究了结直肠癌的症状、病程和定位线索。方法：我们回顾了从1983-87年在一个地区转诊中心连续204例结直肠癌患者的医院和办公室记录，这些患者在出现症状后首次诊断。我们提取了人口学特征、15种症状的存在和持续时间以及肿瘤特征的数据。结果：研究中纳入的194例患者在年龄、性别、肿瘤位置（58%远端脾屈曲）和分期（56% A期或B期）方面与其他地方的结直肠癌患者相似。最常见的症状是直肠出血（58%）、腹痛（52%）和排便习惯改变（51%）；大多数患者有贫血（57%）和隐蔽性出血（77%）。症状的中位持续时间（从发病到诊断）为14周（四分位数范围5-43）。我们发现症状的总持续时间和肿瘤的分期之间没有关联。患者的年龄、性别和癌的近端位置也与诊断前较长的症状持续时间无关。我们开发了一个规则预测远端位置的癌症使用多元逻辑回归。独立预测因子为（比值比[95% CI]）： Hb (1.34 / g/dl [1.16-1.54])；直肠出血（3.45 [1.71-6.95]）；便秘（3.16 [1.38-7.24]）；近端症状（厌食、恶心、呕吐、腹痛或疲劳至少一种）（0.48[0.20-1.02]）。该规则的灵敏度为93%，特异性为47%，ROC曲线下面积为0.79。结论：在预防结直肠癌更加普遍之前，我们必须继续依靠临床发现来检测这种癌症。我们的研究结果将提醒医生对结直肠癌的“慢性”胃肠道症状进行鉴别诊断，我们的决策规则可能会提示早期结肠镜检查。(C) 1999 by Am。科尔。胃肠病学。
OBJECTIVE: Most colorectal cancers still present with symptoms because screening, although effective, is not yet widely practiced. A careful history and physical examination are still the usual methods for suspecting colorectal cancer and ordering appropriate investigation. Therefore, we studied the symptoms, duration, and clues to location of colorectal cancer.METHODS: We reviewed both hospital and office records for 204 consecutive patients with colorectal cancer, first diagnosed after symptoms, at one regional referral center from 1983-87. We abstracted data on demographic characteristics, presence and duration of 15 symptoms, and characteristics of the tumors.RESULTS: The 194 patients included in the study were similar to those with colorectal cancer described elsewhere in terms of age, gender, and tumor location (58% distal to the splenic flexure), and stage (56% stage A or B). The most common symptoms were rectal bleeding (58%), abdominal pain (52%), and change in bowel habits (51%); the majority had anemia (57%) and occult bleeding (77%). The median duration of symptoms (from onset to diagnosis) was 14 wk (interquartile range 5-43). We found no association between overall duration of symptoms and the stage of the tumor. Patient age, gender, and proximal cancer location were also not associated with a longer duration of symptoms before diagnosis. We developed a rule for predicting a distal location of cancer using multiple logistic regression. Independent predictors were (odds ratio [95% CI]): Hb (1.34 for each g/dl [1.16-1.54]); rectal bleeding (3.45 [1.71-6.95]); constipation (3.16 [1.38-7.24]); and proximal symptoms (at least one of anorexia, nausea, vomiting, abdominal pain, or fatigue) (0.48 [0.20-1.02]). The rule had sensitivity of 93% and a specificity of 47%, with an area under the ROC curve of 0.79.CONCLUSIONS: Until prevention of colorectal cancer is more common, we must continue to rely on clinical findings for detecting this cancer. Our results will remind physicians to keep colorectal cancer on the differential diagnosis of "chronic" gastrointestinal symptoms, and our decision rule may prompt earlier investigation with colonoscopy. (C) 1999 by Am. Coll. of Gastroenterology.