结直肠癌发病率及解剖部位变化趋势
谢正勇,卿三华, 中国人民解放军第一军医大学附属南方医院普外科广东省广州市 510515
项目负责人: 卿三华,510515,广东省广州市南方医院普外科,中国人民解放军第一军医大学附属南方医院普外科. sanhuaq@yahoo.com
电话:020-61641696 传真:020-87280340
收稿日期:2002-12-24 接受日期:2003-01-03
摘要对结直肠癌发病率及解剖部位分布变化趋势进行研究，有利于探索病因及制定合理防治策略.息肉切除术的广泛应用，使西方国家CRC发病率呈下降趋势;而西方化的生活方式和饮食习惯则使得原来低发的许多国家CRC发病率上升.CRC高发国家以结肠癌为主，低发国家则以直肠癌占优势.近年许多学者发现CRC肿瘤部位分布由远端向近端转移，并认为这与远端结直肠癌发病率下降致近端结肠癌所占比例上升有关.年龄、性别、种族、共病等多种因素可影响CRC的解剖部位:老年、女性、黑人、患有糖尿病等共病、有阳性家族史等是CRC分布于近端结肠的高危因素.近端结肠癌预后不良，尤应注意早期诊治，改善预后.
, 百拇医药
谢正勇,卿三华.结直肠癌发病率及解剖部位变化趋势. 世界华人消化杂志 2003;11(7):1050-1053
Parkin DM. Global cancer statistics in the year 2000. Lancet Oncol 2001;2:533-543
2 Wilmink AB. Overview of the epidemiology of colorectal cancer. DisColon Rectum 1997;40:483-493
3 Gonzalez EC, Roetzheim RG, Ferrante JM, Campbell R. Predictors ofproximal vs. distal colorectal cancers. Dis
Colon Rectum 2001;44:251-258
, 百拇医药
4 Zhang YL, Zhang ZS, Wu BP, Zhou DY. Early diagnosis for colorectalcancer inChina .World J Gastroenterol
2002;8:21-25
5 Levin KE, Dozois RR. Epidemiology of large bowel cancer.World JSurg 1991;15:562-567
6 Kim DH, Shin MH, Ahn YO. Incidence pattern of colorectal cancer in Korea of origin. J Korean Med Sci
2000;15:675-681
, http://www.100md.com
7 Bonithon-Kopp C, Benhamiche AM. Are there several colorectalcancers? Epidemiological data. Eur J Cancer Pre
1999;(Suppl 1):S3-12
8 Jia XD, Han C. Chemoprevention of tea on colorectal cancer inducedby dimethylhydrazine in Wistar rats. World
J Gastroenterol 2000;6:699-703
9 Nkondjock A, Shatenstein B, Maisonneuve P, Ghadirian P.Specificfatty acids and human colorectal cancer:
, http://www.100md.com
an overview.CancerDetect Prev 2003;27:55-66
10 Maynard M, Gunnell D, Emmett P, Frankel S, Davey Smith G.Fruit,vegetables, and antioxidants in childhood and risk
of adult cancer: theBoyd Orr cohort. J Epidemiol Community Health 2003;57:218-225
11 Tan W, Lin DX, Xiao Y, Kadlubar F, Chen JS. Chemoprevention of2-amino-1-methyl- 6-phenyli-midazo 4,5-
b pyridine-inducedcarcinogen-DNA adducts by Chinese cabbage in rats.World J Gastroenterol 1999;5:138-142
, 百拇医药
12 Jarvinen R, Knekt P, Hakulinen T, Rissanen H, Heliovaara M.Dietaryfat, cholesterol and colorectal cancer in a
prospective study. BrJ Cancer 2001;85:357-361
13 Troisi RJ,Freedman AN,Devesa SS. Incidence of colorectal carcinomain the U.S: An update of trends by gender,race,age subsite,andstage,1975-1994. Cancer 1999;85:1670-1676
14 Nelson RL, Persky V, Turyk M. Determination of factors responsiblefor the declining incidence of colorectal cancer.
, http://www.100md.com
DisColon Rectum 1999;42:741-745
15 Nelson RL, Dollear T, Freels S, Persky V. The relation ofage,race,and gender to the subsite location of colorectal
carcinoma.Cancer 1997;80:193-197
16 von Eyben FE, Thordal C. Colorectal cancer screening: clinicalguidelines and rationale. Gastroenterology
1997;113:1422-1423
17 Lieberman DA. Cost-effectiveness model for colon cancer screening.Gastraenterology 1995;109:1781-1790
, http://www.100md.com
18 Zheng S, Liu XY, Ding KF, Wang LB, Qiu PL, Ding XF, Shen YZ, ShenGF, Sun QR, Li WD, Dong Q, Zhang SZ. Reduction
of the incidence and mortality of rectal cancer bypolypectomy: a prospective cohort study inHaining County .World
J Gastroenterol 2002;8:488-492
19 De Stefani E, Mendilaharsu M, Deneo-Pellegrini H, Ronco A.Influenceof dietary levels of fat, cholesterol, and calcium
, http://www.100md.com
on colorectal cancer.Nutr Cancer 1997;29:83-89
20 Gerhardsson M, Steineck G, Norell SE. Colorectal cancer in Sweden .A descriptive epidemiologic study. Acta
Oncol 1990;29:855-861
21 al-Azzawi F,Wahab M.Estrogen and colon cancer:current issues.Climacteric 2002;5:3-14
22 Takada H, Ohsawa T, Iwamoto S, Yoshida R, Nakano M, Imada S,Yoshioka K, Okuno M, Masuya Y, Hasegawa K,Kamano N, Hioki K, Muto T, Koyama Y. Changing sitediscription of colorectal cancer in Japan. DisColon Rectum
, 百拇医药
2002;45:1249-1254
23 You W, Jin F, Gridley G, Schatzkin A, Yang G, Rosenberg P, Xiang Y,Hu Y, Li Q. Trends in colorectal cancer rates in
urbanShanghai ,1972-1996,inrelation to dietary changes. Ann Epidemiol 2000;10:469
24 Abou-Zeid AA, Khafagy W, Marzouk DM, Alaa A, Mostafa I, Ela MA.Colorectal cancer inEgypt .Dis Colon
Rectum 2002;45:1255-1260
, http://www.100md.com
25 Soliman AS, Smith MA, Cooper SP, Ismail K, Khaled H, Ismail S,McPherson RS, Seifeldin IA, Bondy ML.
Serum organochlorinepesticide levels in patients with colorectal cancer in Egypt.Arch EnvironHeath 1997;52:409-415
26 AndrewsLG, Johnston JH. Epidemiology of bovine tuberculosis in northern Australia .Acta Vet Scand Suppl
1988;84:139-141
27 Cheng X, Chen VW, Steele B, Ruiz B, Fulton J, Liu L, Carozza SE,Greenlee R. Subsite-specific incidence rate and stage
, http://www.100md.com
of disease incolorectal cancer by race ,gender, and age group in the UnitedStates,1992-1997. Cancer
2001;92:2547-2554
28 Okamoto M, Shiratori Y, Yamaji Y, Kato J, Ikenoue T, Togo G,Yoshida H, Kawabe T, Omata M. Relationship between
age and site ofcolorectal cancer based on colonscopy findings.Gastrointestinal Endoscopy 2002;55:548-551
29 Marcella S, Miller JE. Racial differences in colorectal cancermortality:the importance of stage and socioeconomic
, http://www.100md.com
status.J ClinEpidemiol 2001;54:359-366
30 Iacopetta B. Are there two sides to colorectal cancer? Int J Cacer 2002;101:403-408
31 Makin GB, Breen DJ, Monson JR. The impact of new technology onsurgery for colorectal cancer. World J
Gastroenterol 2001;7:612-621
32 Snyder DN, Heston JF, Meigs JW, Flannery JT. Changes in sitedistribution of colorectal carcinoma in Connecticut,1940-1973.Am J Dig Dis 1977;22:791-797
, 百拇医药
33 Vassilopoulos PP, Kelessis N, Plataniotis G, Gondikakis E, GalanosA. Colorectal cancer trends by anatomic sides,age
and staging.Atwenty-year study of 1412 Greek cases. Anticancer Res 2000;20:4773-4776
34 Cucino C, Buchner AM, Sonnenberg A. Continued rightward shift ofcolorectal cancer. Dis Colon Rectum
2002;45:1035-1040
35 Davila J, El-Serag H, Rabeneck L. #68 Is there a true"shift" to the right in the incidence of colorectalcancer?
, 百拇医药
Ann Epidemiol 2002;12:515
36 Miller A, Gorska M, Bassett M. Proximal shift of colorectal cancerin the Australian Capital Terriory over 20 years. Aust
N Z J Med 2000;30:221-225
37 Wan J, Zhang ZQ, Zhu C, Wang MW, Zhao DH, Fu YH, Zhang JP, Wang YH,Wu BY. Colonoscopic screening and follow-
up for colorectalcancer in the elderly. World J Gastroenterol 2002;8:267-269
, 百拇医药
38 Ma QY, Williamson KE, Rowlands BJ. Variability of cellproliferation in the proximal and distal colon of normal rats and
rats withdimethylhydrazine induced carcinogenesis. World J Gastroenterol 2002;8:847-852
39 Yuan P, Sun MH, Zhang JS, Zhu XZ, Shi DR. APC and K-ras genemutation in aberrant crypt foci of human colon. World
J Gastroenterol 2001;7:352-356
40 Luo MJ, Lai MD. Identification of differentially expressed genes innormal mucosa, adenoma and adenocarcinoma of
, 百拇医药
colon by SSH. World JGastroenterol 2001;7:726-31
41 Slattery ML, Friedman GD, Potter JD, Edwards S, Caan BJ, SamowitzW. A description of age,sex,and site distributions
of colon carcinoma inthree geographic areas. Cancer 1996;78:1666-1670
42 Arai T, Takubo K, Sawabe M,Esaki Y. Pathologic characteristics of colorectal cancer in the elderly: aretrospective study
, http://www.100md.com
of 947 surgical cases.J Clin Gastroenterol 2000;31:67-72
43 卿三华,饶开运,蒋会勇,WexnerSD.原发性结直肠癌解剖部位在美国白人与中国人之间分布趋势的比较.
中华胃肠外科杂志 2002;5:123-125
44 Hu FB, Manson JE, Liu S, Hunter D, Colditz GA, Michels KB, SpeizerFE, Giovannucci E. Prospective study of adult
onset diabetesmellitus(type 2) and risk of colorectal cancer in women.J Natl Cancer Ins 1999;91:542-547
, 百拇医药
45 Bufill JA. Colorectal cancer: evidence for distinct geneticcategories based on proximal or distal tumor location. Ann
Intern Med 1990;113:779-788
46 Stange K, Flocke SA, Goodwin MA. Opportunistic preventive servicedelivery, Are limitations and patient satisfaction
barriers? J Fam Pract 1998;46:419-424
47 Bostick RM, Sprafka JM, Virnig BA, Potter JD. Predictors of cancerprevention attitudes and participation in cancer
, 百拇医药
screeningexaminations. Prev Med 1994;23:816-826
48 Levein NG, Thorn SE, Wattwil M. Dopamine delays gastric emptyingand prolongs orocaecal transit time in volunteers.
Eur J Anaesthesiol 1999;16:246-250
49 Rosa-e-Silva L, Troncon LE, Oliveira RB, Foss MC, Braga FJ, GalloJunior L. Rapid distal small bowel transit associated
with sympatheticdenervation in type I diabetes mellitus. Gut 1996;39:748-756, http://www.100md.com( 谢正勇, 卿三华)
项目负责人: 卿三华,510515,广东省广州市南方医院普外科,中国人民解放军第一军医大学附属南方医院普外科. sanhuaq@yahoo.com
电话:020-61641696 传真:020-87280340
收稿日期:2002-12-24 接受日期:2003-01-03
摘要对结直肠癌发病率及解剖部位分布变化趋势进行研究，有利于探索病因及制定合理防治策略.息肉切除术的广泛应用，使西方国家CRC发病率呈下降趋势;而西方化的生活方式和饮食习惯则使得原来低发的许多国家CRC发病率上升.CRC高发国家以结肠癌为主，低发国家则以直肠癌占优势.近年许多学者发现CRC肿瘤部位分布由远端向近端转移，并认为这与远端结直肠癌发病率下降致近端结肠癌所占比例上升有关.年龄、性别、种族、共病等多种因素可影响CRC的解剖部位:老年、女性、黑人、患有糖尿病等共病、有阳性家族史等是CRC分布于近端结肠的高危因素.近端结肠癌预后不良，尤应注意早期诊治，改善预后.
, 百拇医药
谢正勇,卿三华.结直肠癌发病率及解剖部位变化趋势. 世界华人消化杂志 2003;11(7):1050-1053
Parkin DM. Global cancer statistics in the year 2000. Lancet Oncol 2001;2:533-543
2 Wilmink AB. Overview of the epidemiology of colorectal cancer. DisColon Rectum 1997;40:483-493
3 Gonzalez EC, Roetzheim RG, Ferrante JM, Campbell R. Predictors ofproximal vs. distal colorectal cancers. Dis
Colon Rectum 2001;44:251-258
, 百拇医药
4 Zhang YL, Zhang ZS, Wu BP, Zhou DY. Early diagnosis for colorectalcancer inChina .World J Gastroenterol
2002;8:21-25
5 Levin KE, Dozois RR. Epidemiology of large bowel cancer.World JSurg 1991;15:562-567
6 Kim DH, Shin MH, Ahn YO. Incidence pattern of colorectal cancer in Korea of origin. J Korean Med Sci
2000;15:675-681
, http://www.100md.com
7 Bonithon-Kopp C, Benhamiche AM. Are there several colorectalcancers? Epidemiological data. Eur J Cancer Pre
1999;(Suppl 1):S3-12
8 Jia XD, Han C. Chemoprevention of tea on colorectal cancer inducedby dimethylhydrazine in Wistar rats. World
J Gastroenterol 2000;6:699-703
9 Nkondjock A, Shatenstein B, Maisonneuve P, Ghadirian P.Specificfatty acids and human colorectal cancer:
, http://www.100md.com
an overview.CancerDetect Prev 2003;27:55-66
10 Maynard M, Gunnell D, Emmett P, Frankel S, Davey Smith G.Fruit,vegetables, and antioxidants in childhood and risk
of adult cancer: theBoyd Orr cohort. J Epidemiol Community Health 2003;57:218-225
11 Tan W, Lin DX, Xiao Y, Kadlubar F, Chen JS. Chemoprevention of2-amino-1-methyl- 6-phenyli-midazo 4,5-
b pyridine-inducedcarcinogen-DNA adducts by Chinese cabbage in rats.World J Gastroenterol 1999;5:138-142
, 百拇医药
12 Jarvinen R, Knekt P, Hakulinen T, Rissanen H, Heliovaara M.Dietaryfat, cholesterol and colorectal cancer in a
prospective study. BrJ Cancer 2001;85:357-361
13 Troisi RJ,Freedman AN,Devesa SS. Incidence of colorectal carcinomain the U.S: An update of trends by gender,race,age subsite,andstage,1975-1994. Cancer 1999;85:1670-1676
14 Nelson RL, Persky V, Turyk M. Determination of factors responsiblefor the declining incidence of colorectal cancer.
, http://www.100md.com
DisColon Rectum 1999;42:741-745
15 Nelson RL, Dollear T, Freels S, Persky V. The relation ofage,race,and gender to the subsite location of colorectal
carcinoma.Cancer 1997;80:193-197
16 von Eyben FE, Thordal C. Colorectal cancer screening: clinicalguidelines and rationale. Gastroenterology
1997;113:1422-1423
17 Lieberman DA. Cost-effectiveness model for colon cancer screening.Gastraenterology 1995;109:1781-1790
, http://www.100md.com
18 Zheng S, Liu XY, Ding KF, Wang LB, Qiu PL, Ding XF, Shen YZ, ShenGF, Sun QR, Li WD, Dong Q, Zhang SZ. Reduction
of the incidence and mortality of rectal cancer bypolypectomy: a prospective cohort study inHaining County .World
J Gastroenterol 2002;8:488-492
19 De Stefani E, Mendilaharsu M, Deneo-Pellegrini H, Ronco A.Influenceof dietary levels of fat, cholesterol, and calcium
, http://www.100md.com
on colorectal cancer.Nutr Cancer 1997;29:83-89
20 Gerhardsson M, Steineck G, Norell SE. Colorectal cancer in Sweden .A descriptive epidemiologic study. Acta
Oncol 1990;29:855-861
21 al-Azzawi F,Wahab M.Estrogen and colon cancer:current issues.Climacteric 2002;5:3-14
22 Takada H, Ohsawa T, Iwamoto S, Yoshida R, Nakano M, Imada S,Yoshioka K, Okuno M, Masuya Y, Hasegawa K,Kamano N, Hioki K, Muto T, Koyama Y. Changing sitediscription of colorectal cancer in Japan. DisColon Rectum
, 百拇医药
2002;45:1249-1254
23 You W, Jin F, Gridley G, Schatzkin A, Yang G, Rosenberg P, Xiang Y,Hu Y, Li Q. Trends in colorectal cancer rates in
urbanShanghai ,1972-1996,inrelation to dietary changes. Ann Epidemiol 2000;10:469
24 Abou-Zeid AA, Khafagy W, Marzouk DM, Alaa A, Mostafa I, Ela MA.Colorectal cancer inEgypt .Dis Colon
Rectum 2002;45:1255-1260
, http://www.100md.com
25 Soliman AS, Smith MA, Cooper SP, Ismail K, Khaled H, Ismail S,McPherson RS, Seifeldin IA, Bondy ML.
Serum organochlorinepesticide levels in patients with colorectal cancer in Egypt.Arch EnvironHeath 1997;52:409-415
26 AndrewsLG, Johnston JH. Epidemiology of bovine tuberculosis in northern Australia .Acta Vet Scand Suppl
1988;84:139-141
27 Cheng X, Chen VW, Steele B, Ruiz B, Fulton J, Liu L, Carozza SE,Greenlee R. Subsite-specific incidence rate and stage
, http://www.100md.com
of disease incolorectal cancer by race ,gender, and age group in the UnitedStates,1992-1997. Cancer
2001;92:2547-2554
28 Okamoto M, Shiratori Y, Yamaji Y, Kato J, Ikenoue T, Togo G,Yoshida H, Kawabe T, Omata M. Relationship between
age and site ofcolorectal cancer based on colonscopy findings.Gastrointestinal Endoscopy 2002;55:548-551
29 Marcella S, Miller JE. Racial differences in colorectal cancermortality:the importance of stage and socioeconomic
, http://www.100md.com
status.J ClinEpidemiol 2001;54:359-366
30 Iacopetta B. Are there two sides to colorectal cancer? Int J Cacer 2002;101:403-408
31 Makin GB, Breen DJ, Monson JR. The impact of new technology onsurgery for colorectal cancer. World J
Gastroenterol 2001;7:612-621
32 Snyder DN, Heston JF, Meigs JW, Flannery JT. Changes in sitedistribution of colorectal carcinoma in Connecticut,1940-1973.Am J Dig Dis 1977;22:791-797
, 百拇医药
33 Vassilopoulos PP, Kelessis N, Plataniotis G, Gondikakis E, GalanosA. Colorectal cancer trends by anatomic sides,age
and staging.Atwenty-year study of 1412 Greek cases. Anticancer Res 2000;20:4773-4776
34 Cucino C, Buchner AM, Sonnenberg A. Continued rightward shift ofcolorectal cancer. Dis Colon Rectum
2002;45:1035-1040
35 Davila J, El-Serag H, Rabeneck L. #68 Is there a true"shift" to the right in the incidence of colorectalcancer?
, 百拇医药
Ann Epidemiol 2002;12:515
36 Miller A, Gorska M, Bassett M. Proximal shift of colorectal cancerin the Australian Capital Terriory over 20 years. Aust
N Z J Med 2000;30:221-225
37 Wan J, Zhang ZQ, Zhu C, Wang MW, Zhao DH, Fu YH, Zhang JP, Wang YH,Wu BY. Colonoscopic screening and follow-
up for colorectalcancer in the elderly. World J Gastroenterol 2002;8:267-269
, 百拇医药
38 Ma QY, Williamson KE, Rowlands BJ. Variability of cellproliferation in the proximal and distal colon of normal rats and
rats withdimethylhydrazine induced carcinogenesis. World J Gastroenterol 2002;8:847-852
39 Yuan P, Sun MH, Zhang JS, Zhu XZ, Shi DR. APC and K-ras genemutation in aberrant crypt foci of human colon. World
J Gastroenterol 2001;7:352-356
40 Luo MJ, Lai MD. Identification of differentially expressed genes innormal mucosa, adenoma and adenocarcinoma of
, 百拇医药
colon by SSH. World JGastroenterol 2001;7:726-31
41 Slattery ML, Friedman GD, Potter JD, Edwards S, Caan BJ, SamowitzW. A description of age,sex,and site distributions
of colon carcinoma inthree geographic areas. Cancer 1996;78:1666-1670
42 Arai T, Takubo K, Sawabe M,Esaki Y. Pathologic characteristics of colorectal cancer in the elderly: aretrospective study
, http://www.100md.com
of 947 surgical cases.J Clin Gastroenterol 2000;31:67-72
43 卿三华,饶开运,蒋会勇,WexnerSD.原发性结直肠癌解剖部位在美国白人与中国人之间分布趋势的比较.
中华胃肠外科杂志 2002;5:123-125
44 Hu FB, Manson JE, Liu S, Hunter D, Colditz GA, Michels KB, SpeizerFE, Giovannucci E. Prospective study of adult
onset diabetesmellitus(type 2) and risk of colorectal cancer in women.J Natl Cancer Ins 1999;91:542-547
, 百拇医药
45 Bufill JA. Colorectal cancer: evidence for distinct geneticcategories based on proximal or distal tumor location. Ann
Intern Med 1990;113:779-788
46 Stange K, Flocke SA, Goodwin MA. Opportunistic preventive servicedelivery, Are limitations and patient satisfaction
barriers? J Fam Pract 1998;46:419-424
47 Bostick RM, Sprafka JM, Virnig BA, Potter JD. Predictors of cancerprevention attitudes and participation in cancer
, 百拇医药
screeningexaminations. Prev Med 1994;23:816-826
48 Levein NG, Thorn SE, Wattwil M. Dopamine delays gastric emptyingand prolongs orocaecal transit time in volunteers.
Eur J Anaesthesiol 1999;16:246-250
49 Rosa-e-Silva L, Troncon LE, Oliveira RB, Foss MC, Braga FJ, GalloJunior L. Rapid distal small bowel transit associated
with sympatheticdenervation in type I diabetes mellitus. Gut 1996;39:748-756, http://www.100md.com( 谢正勇, 卿三华)
