早发性结直肠癌的流行病学特征分析:基于单中心前瞻性队列研究  

Epidemiological characteristics of early-onset colorectal cancer:a prospective cohort study from a single center

作　　者：金天 朱应双 刘成成 徐行[2] 陆玮 肖乾 丁克峰[1,3] 郑树 Jin Tian;Zhu Yingshuang;Liu Chengcheng;Xu Xing;Lu Wei;Xiao Qian;Ding Kefeng;Zheng Shu(Department of Colorectal Surgery,Oncology(Key Laboratory of Cancer Prevention and Intervention,China National Ministry of Education,Key Laboratory of Molecular Biology in Medical Sciences,Zhejiang Province,China),the Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Nursing,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China;Center for Medical Research and Innovation in Digestive System Tumors,Hangzhou 310058,China)

机构地区：[1]浙江大学医学院附属第二医院大肠外科、恶性肿瘤预警与干预教育部重点实验室、浙江省恶性肿瘤临床医学研究中心,杭州310009 [2]浙江大学医学院附属第二医院护理部,杭州310009 [3]消化系统医药基础研究创新中心(教育部),杭州310058

出　　处：《中华胃肠外科杂志》2024年第5期457-463,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：“十三五”国家重点研发计划(2017YFC0908200);国家自然科学基金(82103905);浙江省重点研发计划项目“领雁”计划(2023C03049);浙江省自然科学基金(Q23H260015);浙江省卫计委区域诊治中心项目(JBZX-201903)。

摘　　要：目的探究我国早发性结直肠癌(EOCRC)和晚发性结直肠癌(LOCRC)患者中流行病学特征和暴露因素的分布差异,为早发性结直肠癌的预防及临床诊疗提供参考与指导。方法依托于结直肠癌专病队列纳入了2018年6月至2023年2月期间在浙江大学医学院附属第二医院大肠外科首次确诊为原发性结直肠癌的5377例患者,对患者进行基本信息和流行病学信息的问卷调查。并以50岁为年龄分界值进行分组,将年龄≥50岁者定义为LOCRC,年龄<50岁者定义为EOCRC。采用Wilcoxon检验或χ^(2)检验比较EOCRC组与LOCRC组患者的生活方式与饮食习惯等流行病学特征。结果研究共纳入3799例完成基线问卷调查者,问卷应答率70.7%。其中,EOCRC组491例,LOCRC组3308例。EOCRC组患者中位年龄为43岁,LOCRC组患者中位年龄66岁。与LOCRC组一般人口学特征的比较,EOCRC组女性比例偏高[48.5%(253/491)比35.8%(1184/3308),χ^(2)=28.8,P<0.001],体质指数更小(中位数22.1 kg/m^(2)比22.9 kg/m^(2),W=744793,P=0.005),腹型肥胖比例更低[87.2%(428/491)比93.8%(3103/3308),χ^(2)=38.3,P<0.001],合并有高血压[5.9%(29/491)比41.6%(1375/3308),χ^(2)=231.8,P<0.001]、糖尿病[1.4%(7/491)比14.4%(476/3308),χ^(2)=63.6,P<0.001]和心脑血管疾病史[0.8%(4/491)比7.3%(241/3308),χ^(2)=28.6,P<0.001]比例更少,但具有结直肠癌家族史的比例更高[10.2%(50/491)比6.9%(227/3308),χ^(2)=6.5,P=0.010];差异均有统计学意义(均P<0.05)。与LOCRC组生活方式比较,EOCRC组睡眠时长缩短(中位数8.0 h比8.5 h,W=578989,P<0.001),从事体力工作比例偏低[65.2%(320/491)比74.1%(2450/3308),χ^(2)=16.7,P<0.001],更少参加体育锻炼[29.5%(145/491)比38.7%(1281/3308),χ^(2)=15.0,P<0.001],更少有吸烟的习惯[29.3%(144/491)比42.7%(1411/3308),χ^(2)=46.9,P<0.001],吸烟量也更少(中位数17.6包/年比30.0包/年,W=55850,P<0.001),饮酒[21.0%(103/491)比38.0%(1257/3308),χ^(2)=57.5,P<0.001]和喝茶[17.5%(86/491)比28.7%(948/3308),χ^(2)=26.2,P<Objective To explore the differences in distribution of colorectal cancer-related risk factors between patients with early-onset colorectal cancer(EOCRC)and those with late-onset colorectal cancer(LOCRC)in a Chinese cohort,and to provide reference and guidance for the prevention,diagnosis,and treatment of EOCRC.Methods Using data from the National Colorectal Cancer Cohort study cohort,5377 patients with newly diagnosed colorectal cancer(CRC)attending the Department of Colorectal Surgery and Oncology of the Second Affiliated Hospital,Zhejiang University School of Medicine from June 2018 to February 2023 were included in the study cohort.Questionnaires capturing epidemiological features,including lifestyle and dietary habits,were administered.The patients were divided into two groups,the cut-off age being 50 years.Those aged≥50 years were defined as having LOCRC and those aged<50 years as having EOCRC.Wilcoxon(continuous variates)orχ^(2)tests(categorical variates)were performed to compare differences in epidemiological features.Results A total of 3799 people who had completed the questionnaire were included in this study,491 of whom had EOCRC and 3308 LOCRC.The response rate to the questionnaire was 70.7%.The median ages of patients in the EOCRC and LOCRC groups were 43 and 66 years,respectively.There was a higher proportion of female patients(48.5%[253/491]vs.35.8%[1184/3308],χ^(2)=28.8,P<0.001)in the EOCRC than the LOCRC group.Patients with EOCRC and lower body mass index(medium 22.1 kg/m^(2)vs.22.9 kg/m^(2),W=744793,P=0.005)and lower proportion of abdominal obesity(87.2%[428/491]vs.93.8%[3103/3308],χ^(2)=38.3,P<0.001).Patients with EORC significantly less commonly reported a history of hypertension(5.9%[29/491]vs.41.6%[1375/3308],χ^(2)=231.8,P<0.001),diabetes(1.4%[7/491]vs.14.4%[476/3308],χ^(2)=63.6,P<0.001)and cardiovascular and cerebrovascular diseases(0.8%[4/491]vs.7.3%[241/3308],χ^(2)=28.6,P<0.001).However,the proportion of patients with a family history of CRC was significantly higher(P<0.05)in the

关 键 词：结直肠肿瘤 早发性 流行病学特征 饮食习惯 生活方式 

分 类 号：R735.3[医药卫生—肿瘤]