Survival of patients with symptom- and screening-detected colorectal cancer.
Survival of patients with symptom- and screening-detected colorectal cancer.
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DOI：
10.18632/oncotarget.9412
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发表时间：
2016-07-12
期刊：
影响因子：
--
通讯作者：
Hoffmeister M
中科院分区：
文献类型：
--
作者：
Brenner H;Jansen L;Ulrich A;Chang-Claude J;Hoffmeister M
越来越多的结直肠癌（CRC）患者是通过筛查而不是症状诊断出来的。我们的目的是评估和比较筛查检测的CRC患者和症状检测的CRC患者的预后。根据诊断模式（症状、结肠镜筛查、粪便潜血试验[FOBT]等），对2003-2010年在德国招募的2450名年龄在50-79岁的CRC患者进行多中心队列研究，评估中位随访4.8年的总死亡率和CRC特异性死亡率。症状、结肠镜筛查和FOBT检测分别为68%、11%和10%。筛查检测到的癌症比症状检测到的癌症有更有利的分期分布（68%对50%在I期或II期）。与症状检测的癌症相比，经年龄和性别调整的总死亡率风险比（hr） （95% ci）在结肠镜筛查和FOBT检测的crc中分别为0.35（0.24-0.50）和0.36（0.25-0.53）。在调整阶段和多个其他协变量后，hr仅略有减弱，并保持高度显著性（分别为0.50（0.34-0.73）和0.54(0.37-0.80)）。与结直肠癌特异性死亡率的关联甚至更强。筛查检测的III期CRC患者与症状检测的I期或II期CRC患者具有相同的CRC特异性生存率。筛查发现的CRC患者预后非常好，远远超出了其更有利的分期分布所解释的水平。检测方式是一种重要的、易于获得的替代指标，可以在诊断早期阶段之后进行有利的诊断，因此可能对治疗决策中的风险分层有用。
An increasing proportion of colorectal cancer (CRC) patients are diagnosed by screening rather than symptoms. We aimed to assess and compare prognosis of patients with screen-detected CRC and symptom-detected CRC. Overall and CRC specific mortality over a median follow-up of 4.8 years was assessed according to mode of diagnosis (symptoms, screening colonoscopy, fecal occult blood test [FOBT], other) in a multi-center cohort of 2,450 CRC patients aged 50-79 years recruited in Germany in 2003-2010. 68%, 11% and 10% were detected by symptoms, screening colonoscopy and FOBT, respectively. The screen-detected cancers had a more favorable stage distribution than the symptom-detected cancers (68% versus 50% in stage I or II). Age- and sex adjusted hazard ratios (HRs) of total mortality with 95% confidence intervals (95% CIs) compared to symptom-detected cancers were 0.35 (0.24-0.50) and 0.36 (0.25-0.53) for screening colonoscopy and FOBT detected CRCs, respectively. HRs were only slightly attenuated and remained highly significant after adjustment for stage and multiple other covariates (0.50 (0.34-0.73) and 0.54 (0.37-0.80), respectively). Even stronger associations were seen for CRC specific mortality. Patients with screen-detected stage III CRC had as good CRC specific survival as patients with symptom-detected stage I or II CRC. Patients with screen-detected CRC have a very good prognosis far beyond the level explained by their more favorable stage distribution. Mode of detection is an important, easy-to-obtain proxy indicator for favorable diagnosis beyond earlier stage at diagnosis and as such may be useful for risk stratification in treatment decisions.
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影响因子：
24.5
作者：
Logan RF;Patnick J;Nickerson C;Coleman L;Rutter MD;von Wagner C;English Bowel Cancer Screening Evaluation Committee
通讯作者：
English Bowel Cancer Screening Evaluation Committee
DOI：
10.1056/nejmoa1100370
发表时间：
2012-02-23
期刊：
The New England journal of medicine
影响因子：
--
作者：
Zauber AG;Winawer SJ;O'Brien MJ;Lansdorp-Vogelaar I;van Ballegooijen M;Hankey BF;Shi W;Bond JH;Schapiro M;Panish JF;Stewart ET;Waye JD
通讯作者：
Waye JD
影响因子：
3.4
作者：
Pande, R.;Froggatt, P.;Harmston, C.
通讯作者：
Harmston, C.
影响因子：
39.2
作者：
Brenner, Hermann;Chang-Claude, Jenny;Hoffmeister, Michael
通讯作者：
Hoffmeister, Michael
影响因子：
16.9
作者：
Amri, Ramzi;Bordeianou, Liliana G.;Berger, David L.
通讯作者：
Berger, David L.