摘要
目的分析结直肠癌(CRC)流行病学特征及同时性结直肠肝转移(synCRLM)的影响因素,更好为CRC的预防、诊断、治疗和预后判断提供指导和依据。方法以“结直肠肿瘤、肝转移、同时性、流行病学、危险因素”作为中文关键词,以“colorectal neoplasms、liver metastases、synchronous、epidemiology和risk factor”作为英文关键词,检索PubMed、中国知网和万方数据库1999-01-01-2020-06-31相关文献。纳入标准:(1)结直肠癌流行病学特征;(2)结直肠癌发生的相关影响因素;(3)结直肠癌肝转移的影响因素;(4)结直肠癌的病例对照研究。根据纳入标准分析文献68篇(中文11篇,英文57篇)。结果2018年,全球CRC新发病例数>180万例,死亡病例数约88.1万例,各类癌症中CRC全球发病率居第3位(10.2%),病死率居第2位(9.2%)。值得注意的是,美国CRC发病率已逐步下降;而中国CRC发病率与病死率曾经长期维持在极低水平,但近年来快速上升。近年来结肠癌发病率的上升趋势明显迅速于直肠癌。结肠癌在CRC中所占比重越来越大,在部分地区其发病率已经超过了直肠癌的发病率,并呈现出近端化趋势。全球最高发地区与最低发地区的CRC发病率可差>7倍。我国西北等经济水平落后地区CRC发病率显著低于东部沿海等经济水平高的地区。CRC的患病率随着年龄的增长而升高,呈现老年化趋势,其中结肠癌更为显著,高龄成为CRC发病重灾区。中国CRC的平均发病年龄随着时间推移逐渐后移更为显著。整体来看不论是全球还是中国男性CRC的发病率显著高于女性。CRC远处转移是导致患者预后差和死亡率高的主要原因,肝脏常为其转移唯一受累器官。CRC发生及肝转移影响因素众多。中国是乙型肝炎病毒(HBV)感染大国,同时也是脂肪性肝病大国。中国丰富的酒文化也致饮酒者众多,故CRC的研究需要结合我国非肿瘤性慢性肝脏疾病的特殊国情。结论结直肠癌在年龄、性别、病变部位和地域分布等诸多方面均有其特征,慢性乙型病毒性肝炎、酒精性肝病和非酒精性脂肪性肝病等也影响着结直肠癌肝转移,结直肠癌及结直肠癌肝转移的研究需要结合我国慢性肝病的特殊国情。
Objective To analyze the epidemiological characteristics of CRC and the influencing factors of synchronous colorectal liver metastasis(synchronous colorectal liver metastasis»synCRLM)in colorectal cancer,so as to provide better guidance and basis for the prevention,diagnosis,treatment and prognosis of CRC.Methods Using"colorectal neoplasms,liver metastases,synchronous,epidemiology,risk factors"as the English key words,we searched for relevant literatures published in PubMed,CNKI and Wanfang database from 1999-01-01 to 2020-06-31.Inclusion criteria:(1)Epidemiological characteristics of colorectal cancer;(2)the factors contribute to colorectal cancer occurrence;(3)the factors contribute to synchronous colorectal liver metastasis;(4)case-control study of colorectal cancer.A total of 68 articles(11 in Chinese and 57 in English)were analyzed according to the inclusion criteria.Results In 2018,the number of new cases of CRC in the world exceeded 1.8 million and the number of deaths was about 881000.Among all kinds of cancers,the global incidence of CRC ranks the third(10.2%)and the mortality ranks the second(9.2%).However.it is worth noting that the incidence of CRC in the United States has gradually declined,while the incidence and mortality of CRC in China have been kept at a very low level for a long time.but have increased rapidly in recent years.In recent years,the rising trend of the incidence of colon cancer is obviously faster than that of rectal cancer.Colon cancer accounts for an increasing propor tion in CRC.In some areas,the incidence of colon cancer has exceeded the incidence of rectal cancer,and shows a near-end trend.The incidence rate of CRC in the highest risk areas globally is 7 times higher than that in the lowest risk areas.Sim ilarly,its incidence in remote and backward areas,like the northwest area in China,is significantly lower than that in east ern coastal cities which have higher economic level.The prevalence rate of CRC increases with the increase of age,showing an aging trend,in which colon cancer is more significant,and the elderly has become the hardest hit population of CRC.The average age of onset of CRC in China has gradually shifted more significantly with the passage of time.Overall,the in cidence of CRC in males in both the world and China is significantly higher than that in females.Distant metastasis of CRC is the main cause of poor prognosis and high mortality,and the liver is often the only organ involved.There are many factors affecting the occurrence and liver metastasis of CRC.China is not only a big country of HBV infection»but also a big country of fatty liver disease.China's rich alcohol culture also leads to a large number of drinkers,so the study of CRC needs to be combined with the special situation of non-neoplastic chronic liver disease in China.Conclusions Colorectal cancer has its characteristics in many aspects,such as age,sex,lesion location.regional distribution and so on.Chronic hep atitis B,alcoholic liver disease and non-alcoholic fatty liver disease also affect liver metastasis of colorectal cancer.The study of colorectal cancer and liver metastasis of colorectal cancer needs to be combined with the special situation of chron ic liver disease in China.
作者
田传鑫
赵磊
TIAN Chuan-xin;ZHAO Lei(School of Medicine,Shandong University,Jinan 250012,China;Department of Hepatobiliary Surgery,Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Sciences,Jitian 250117,China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2021年第13期1033-1038,共6页
Chinese Journal of Cancer Prevention and Treatment
关键词
结直肠肿瘤
肝转移
同时性
流行病学
危险因素
综述文献
colorectal neoplasms
liver metastases
synchronous
epidemiology
risk factors
review literature
