Töf á greiningu ristilkrabbameina, tengsl við stigun og lífshorfur : afturskyggn rannsókn frá Landspítalanum 1980-1892

Abstract

Introduction: Delay is common in diagnosis of colon cancer, its prognostic effect, however, is debatable. A retrospective study of patients with colon cancer was carried out at Landspitalinn University Hospital, covering a period of 12 years. Symptoms and survival were noted, as well as delay in diagnosis. Material and methods: One hundred seventy eight patients were diagnosed with colon cancer during the 13 year period (1980-1992), 92 males and 86 females, with a median age of 70 years (range 19-96 years). One hundred sixty six patients underwent operations and overall surgical mortality was 7.2%. The patients' symptoms on arrival at the hospital were noted, as well as the length of time from their onset. Also noted was the patients' hemoglobin level. Patients were staged according to Duke's classification, survival calculated, and Cox Multivariate Analysis was carried out. For the benefit of our study the colon was devided into right and left halves at the splenic flexure in order to compare possible differences of the two halves. Results: Most patients, 168/178, were diagnosed on the bases of their symptoms, most commonly anaemia, bloody stools and abdominal pain. Of the patients 38% suffered delay in diagnosis and treatment of more than three months from the onset of symptoms, a similar rate for patients with right and left tumors. More left tumors than right were diagnosed within one week from the onset of symptoms (right 7%, left 17.5%). The median hemoglobin value was 115g/L (standard deviation 24.5 g/L). One hundred seventy four patients were staged according to Duke, of which 17 were Duke's A, 60 B and 51 Duke's C. Forty six patients had distant metastases at diagnosis, most commonly liver metastases. Five year survival was 43%, appoximately the same for the sexes, 68% for Duke's A and 9% for Duke's „D". No significant difference was found in the staging and survival of patients with left and right colon cancers, hemoglobin concentration less or more than 110 g/L; or of patients whose delay in diagnosis was shorter or longer than three months after the onset of symptoms. Only increased age at the time of diagnosis, and unfavourable Duke's staging, proved to be independent risk factors according to Cox Multivariate Analysis. Conclusion: Symptoms, staging and survival of patients with colon cancer at Landspitalinn during the 12 year time period studied, proved to be similar to reports from our neighbouring countries, though in our study more patients were unfavourably Duke's staged (C or „D"). The delay in diagnosis from the onset of symptoms was also similar to that reported by foreign authors. It is clear that a considerable delay is common, however, it does not seem to bring about less favourable staging or worse survival.

Inngangur: Töf verður oft á greiningu ristilkrabbameins en áhrif hennar á horfur sjúklinga eru umdeild. Rannsóknin var afturskyggn og náði til sjúklinga með ristilkrabbamein á 13 ára (1980-1992) tímabili á Landspítalanum. Athuguð var töf á greiningu þeirra, stigun og lífshorfur. Efniviður og aðferðir: Eitt hundrað sjötíu og átta sjúklingar greindust með ristilkrabbamein. Karlar voru 92, konur 86 og meðalaldur 70 ár (bil 19-96 ár). Eitt hundrað sextíu og sex sjúklingar gengust undir skurðaðgerð og var skurðdauði 7,2%. Skráð voru einkenni, tímalengd einkenna og blóðrauði við komu. Sjúklingarnir voru stigaðir (samkvæmt stigunarkerfi Dukes), lífshorfur reiknaðar og áhrif ýmissa breyta á líftímann voru athugaðar með fjölbreytugreiningu. Samanburður var gerður á hægri og vinstri ristilkrabbameinum en skipting í hægri og vinstri miðaðist við miltisbugðu. Niðurstöður: Flestir, eða 168 af 178, greindust vegna einkenna og voru blóðleysi, blóð í hægðum og kviðverkir þeirra algengust. Af sjúklingum höfðu 38% einkenni lengur en þrjá mánuði fyrir greiningu og var það hlutfall svipað fyrir hægri og vinstri æxli. Fleiri vinstri æxli greindust innan viku (hægri 7% en vinstri 17,5%). Meðalgildi blóðrauða alls hópsins við greiningu var 115 g/1 (staðalfrávik 24,5 g/1), en það reyndist marktækt lægra hjá sjúklingum með hægri ristilkrabbamein samanborið við vinstri. Upplýsingar um stigun lágu fyrir hjá 174 sjúklingum, þar af voru 17 á Dukes stigi A, 60 á stigi B, 51 á stigi C. Fjarmeinvörp (stig „D") höfðu 46 sjúklingar og voru meinvörp í lifur algengust. Ekki reyndist marktækur munur á stigun eða lífshorfum sjúklinga með hægri og vinstri æxli. Fimm ára lífshorfur voru 43%, sambærilegar fyrir bæði kynin, 68% á stigi A og 9% á stigi „D". Ekki var marktækur munur á stigun og lífshorfum sjúklinga með hægri og vinstri æxli, blóðrauða minni eða meiri en 110 g/1 við greiningu eða einkenni skemur eða lengur en þrjá mánuði fyrir greiningu. Einungis hækkandi aldur við greiningu og Dukes stig reyndust sjálfstæðir áhættuþættir samkvæmt fjölbreytugreiningu Cox (Cox multivariate analysis). Ályktun: Einkenni, stigun og lifshorfur sjúklinga með ristilkrabbamein á Landspítalanum á fyrrgreindu árabili eru sambærileg við nágrannalönd en hlutfallslega margir hafa útbreiddan sjúkdóm (stig C og „D"). Tímalengd einkenna fyrir greiningu er sömuleiðis sambærileg við erlendar rannsóknir en ljóst er að oft verður veruleg töf á greiningu. Aukinni töf á greiningu virðist þó ekki fylgja hærri stigun eða verri lifshorfur.