美国白人与中国人原发性结直肠癌病理特点对照

Comparison of pathologic characteristics of primary colorectal cancer between American Caucasian and Chinese patients

目的 比较研究美国白人与中国患者原发性结直肠癌 (CRC)的病理学特征。方法 回顾性分析 1990～ 2 0 0 0年美国克里夫兰佛罗里达临床中心结直肠外科 6 90例和中国第一军医大学南方医院普外科 870例连续完整的CRC患者资料。结果 美国白人与中国患者比较 :36 .3%比 2 6 .0 %的肿瘤位于近侧 (右侧 )结肠 (P <0 .0 0 1) ,6 3.7%比 74 .0 %位于远侧 (左侧 )结肠 (P <0 .0 0 1) ;中位年龄 72比5 4岁 (P <0 .0 0 1) ;腺癌 84 .3%比 85 .3% ,黏液腺癌 13.6 %比 11.4 % ,印戒细胞癌 1.5 %比 2 .7% ,腺鳞癌 0 .6 %比 0 .6 % (P >0 .0 5 ) ;高分化癌 16 .7%比 4 0 .2 % ,中分化 6 1.9%比 4 8.5 % ,低分化 2 1.4 %比11.3% (P <0 .0 0 1) ,近侧结肠癌中低分化比例在两种族患者中均较高 ;TNM分期 ,0期 5 .4 %比 1.3%(P <0 .0 0 1) ,Ⅰ期 34.8%比 18.9% (P <0 .0 0 1) ,Ⅱ期 2 9.9%比 33.2 % (P >0 .0 5 ) ,Ⅲ期 2 0 .3%比2 2 .8% (P >0 .0 5 ) ,Ⅳ期 9.6 %比 17.0 % (P <0 .0 0 1)。进展期癌更常见于近侧结肠和中国患者。结论 美国白人易患近侧结肠癌 ,中国患者远侧结直肠癌更常见 ,进展期比例高 ,年龄明显小。低分化和进展期癌更常见于近侧结肠。

Objective To compare the pathologic characteristics of primary colorectal cancer (CRC) between American Caucasian and Chinese patients. Methods A retrospective study was undertaken. Data was collected from 690 patients in Cleveland Clinic Florida USA, and 870 patients in Nanfang Hospital in China from 1990 to 2000. All the patients with CRC were diagnosed by surgery and histology. Results Overall 36.3% of Caucasian patients vs. 26.0% of Chinese patients had lesions in the proximal colon and 63.7 % vs. 74.0% had cancers located on distal colorectum ( P <0.001). The median age was 72 years in Caucasian patients vs. 54 years in Chinese patients ( P <0.001). The proportion of histological types was not significantly different between two race groups ( P >0.05). The proportion of adenocarcinomas was significantly greater in proximal colon among Caucasian patients than among Chinese patients ( P <0.001). Overall, 16.7% in Caucasian patients vs. 40.2% in Chinese patients were differentiated adenocarcinoma ( P <0.001), 61.9% vs. 48.5% moderately differentiated ( P <0.001), and 21.4% vs. 11.3% poorly differentiated ( P <0.001). Higher proportion of poorly differentiatied cancer was in proximal colon in two groups. In staging, 5.4% of Caucasian patients vs. 1.3% of Chinese patients were stage 0 ( P < 0.001), 34.8% vs. 18.9% were stage Ⅰ ( P < 0.001), 29.9% vs. 33.2% were stage Ⅱ( P >0.05), 20.3% vs. 22.8% were stage Ⅲ( P > 0.05), 9.6% vs. 17.0% were stage Ⅳ ( P <0.001). Later-stage was more frequently in the proximal colon than in the distal colorectum in two different race groups. Further Caucasian patients had higher proportion of later-stage than Chinese patients did in proximal colon cancer.Overall Chinese patients were more likely to be later-stage cancer than Caucasian patients were. Conclusions America Caucasian patients have a higher risk of proximal CRC, Chinese patients were more likely to have distal CRC, poorly differentiated, later-stage cancer was more frequently to be located in proximal colon, Chinese patients was more likely to be later-stage.