Abstract
ObjectiveThe clinical and biological characteristics of colorectal cancer have been found to differ depending on the anatomic site of the cancer. However, for Chinese patients, there is limited information on the proportion of cases at each site and the related features. In this study, we explored the location, distribution and other features of colorectal cancers at each anatomic site in Chinese patients.MethodsWe conducted a hospital-based study using hospitalization summary reports from 10 Peking University-affiliated hospitals from 2014 to 2018; the reports covered a total of 2,097,347 hospitalizations. Incident cases were chosen as the study population, and their epidemiological features were further analyzed.ResultsA total of 20,739 colorectal cancer patients were identified. Rectum was the most common location (48.3%) of the cancer, whereas the proportions of patients with distal and proximal colon cancer were 24.5% and 18.6%, respectively. Patients with rectal cancer were predominantly male and were the youngest for all anatomical sites (each P<0.001). The highest proportion of emergency admissions, the longest hospital stays and the highest hospitalization costs were found in patients with proximal colon cancer (each P<0.001). The proximal colon cancer subgroup included the highest proportions of patients with medical histories of cholecystectomy, cholecystolithiasis and/or gallbladder polyps and appendectomy (P=0.009, P<0.001 and P<0.001, respectively). The distal colon cancer subgroup included the highest proportions of patients with medical histories of diabetes and hypertension (P<0.001, respectively).ConclusionsThe patterns of colorectal cancer observed in this study differ from those reported for Western patients and show a significantly higher proportion of patients with rectal cancer. Different epidemiological features were also found based on anatomic sites. Further studies based on tumor location should be conducted to facilitate more accurate screening and treatment.
Highlights
With modern changes in lifestyle, colorectal cancer (CRC) has become the most common malignant tumor of the digestive system in the past 20 years [1]
In this study, we aimed to summarize the epidemiological features of CRC patients in China stratified by anatomic site; the features studied included the proportions, basic characteristics, associated risk factors and other trends based on 5-year hospitalization summary reports (HSRs) provided by university-affiliated comprehensive hospitals
This study aimed to estimate the proportion of cases of CRC at different anatomic sites and to summarize differences in the epidemiological features among proximal colon cancer, distal colon cancer and rectal cancer
Summary
With modern changes in lifestyle, colorectal cancer (CRC) has become the most common malignant tumor of the digestive system in the past 20 years [1]. According to the latest statistics released by the American Cancer Society, CRC was predicted to have the third highest morbidity and mortality rates in 2020, with 147,950 newly diagnosed cases and more than 50,000 deaths [2]. Many epidemiological studies have found that the average age of patients with CRC is decreasing: a nationwide study in the United States revealed that the number of newly diagnosed cases and deaths in patients under the age of 50 years old will reach 17,930 and 3,640, respectively, in 2020; this represents a significant upward trend compared with previous years [4]. A number of large population-based studies conducted in recent years in other developed countries showed significant upward trends in the proportion of newly diagnosed CRC patients younger than 50 years [5,6]. The high morbidity and mortality and the trend toward a younger age at onset make this disease increasingly intractable [7,8]
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