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目的研究1990—2005年杭州市萧山区人群结、直肠癌的发病部位和年龄特点及生存率影响因素。方法以杭州市萧山区恶性肿瘤发病与死亡监测系统为基础,采用寿命表法计算结、直肠癌的生存率,分析结、直肠癌的发病年龄、部位、生存率的变化趋势及其影响因素。结果 1990—2005年结、直肠癌病例共2450例,中位发病年龄65.3岁,1990—1995年、1996—2000年、2001—2005年中位发病年龄分别为63.2岁、65.3岁、66.8岁,结、直肠癌病例的发病年龄呈增高趋势。结肠癌中位发病年龄64.5岁,低于直肠癌病人中位发病年龄(65.8岁),差别有统计学意义(Z=2.06,P=0.039)。发病部位以直肠癌为主,占60.2%,60岁以下发病的病人中结肠癌的比例高于60岁以上年龄组。近年来结肠癌的比例呈增高趋势,2001—2005年已占全部结、直肠癌患者的46.6%。本组结、直肠癌病人的1年、3年、5年生存率分别为51.5%,45.6%和43.4%。影响结、直肠癌预后的主要因素有肿瘤部位[直肠癌相对危险度是结肠癌的1.453倍(95%CI:1.293～1.633)]、发病年龄[45～59岁组和≥60岁组的相对危险度分别为<45岁组的1.071倍(95%CI:0.867～1.325)和1.847倍(95%CI:1.535～2.222)]、诊断时期[1996—2000年和2001年以后的相对危险度分别为1996年以前的0.901倍(95%CI:0.788～1.030)和0.691倍(95%CI:0.600～0.795)]。结论结、直肠癌病人有发病年龄增高、发病部位趋向近端、预后改善的趋势,须针对发病特征及相关影响因素采取积极有效的预防措施。
Objective To study the incidence and age of colorectal cancer in Xiaoshan District, Hangzhou City from 1990 to 2005 and its influencing factors. Methods Based on the monitoring system of morbidity and mortality of malignant tumor in Xiaoshan District, Hangzhou City, the survival rate of node and colorectal cancer was calculated by life table method. The change trend and influencing factors of age, location and survival rate of node, colorectal cancer were analyzed. Results Between 1990 and 2005, there were 2450 cases of rectal cancer with a median age of onset of 65.3 years. The median age of onset was 63.2 years, 65.3 years and 66.8 years from 1990 to 1995, 1996-2000 and 2001-2005 respectively. The age of onset of colorectal cancer showed an increasing trend. The median age at onset of colon cancer was 64.5 years, which was lower than the median age at onset of rectal cancer (65.8 years). The difference was statistically significant (Z = 2.06, P = 0.039). The incidence of rectal cancer-based site, accounting for 60.2%, the incidence of colon cancer in patients under the age of 60 higher than the proportion of 60 years of age or older. In recent years, the proportion of colon cancer showed an increasing trend, accounting for 46.6% of all patients with colorectal cancer from 2001 to 2005. The 1-year, 3-year and 5-year survival rates of patients with rectal cancer in our study group were 51.5%, 45.6% and 43.4%, respectively. The main factors affecting the prognosis of colorectal cancer are tumor site [relative risk of rectal cancer is 1.453 folds of colon cancer (95% CI: 1.293-1.633)], age of onset [45- 59 years old and ≥ 60 years old relative The risk was 1.071 times (95% CI: 0.867 to 1.325) and 1.847 times (95% CI: 1.535 to 2.222), respectively, in the 45-year-old group. The relative risk in the diagnosis period (1996-2000 and 2001 respectively) 0.901 times (95% CI: 0.788 to 1.030) and 0.691 times (95% CI: 0.600 to 0.795) before 1996]. Conclusions The patients with colorectal cancer have the tendency of getting older, getting closer to the site of disease and improving the prognosis. Active and effective preventive measures should be taken according to the characteristics of the disease and the related factors.