AJG：种族与结直肠癌预后相关

结直肠癌是常见的恶性肿瘤。在美国其致死率在所有恶性肿瘤中位居第二。尽管有大量证据证实早期筛查可以明显降低结直肠癌的死亡率，但在一般人群中应用仍很不彻底。美国加州大学医学院消化病及肝病科的Chanda Ho等人比较了结直肠癌易感人群和全国代表性数据中结直肠癌分期及预后的表现，得出在易感人群中根据种族不同而有所侧重的进行结直肠癌筛查可有效提高筛查的利用率并改善患者预后，这一结果发表在2013年5月的The American journal of Gastroenterology上。

作者进行分析的结直肠癌病例来源于旧金山综合医院以及流行病学监测和最终结果数据库。结果发现由旧金山综合医院中获得的病例人群中有55%处于结直肠癌进展期（分期更高），而这一比例在流行病学监测和最终结果数据库获得的病例人群中为44%。与流行病学监测和最终结果数据库获得的病例人群相比较，旧金山综合医院中获得的病例人群黑人以及亚洲人处于结直肠癌进展期的风险增加最为明显。证实旧金山综合医院中获得的病例人群的较流行病学监测和最终结果数据库获得的病例人群的预后差，但证据并不充分。

不同种族预后分析显示，在旧金山综合医院中获得的病例人群中黑种人及白种人预后较差，但也有一些证据表明亚洲人的预后较好。在旧金山综合医院中获得的病例人群中，亚洲人及西班牙裔人的预后较白种人及黑种人好。在旧金山综合医院中建立了保健档案，其中44%的人群在发病1年内成功诊断出结直肠癌。但是在旧金山综合医院建立保健档案1年及以上的人群中仅22%进行了结直肠癌筛查检测。

上述实验结果证实在结直肠癌易感人群中可以根据种族采取不同侧重进行筛查，并指出哪些地方充分利用结直肠癌筛查可以使易感人群预后得到改善。

Late presentation of colorectal cancer in a vulnerable population.
OBJECTIVES
We examined colorectal cancer (CRC) stage at presentation and mortality in a vulnerable population compared with nationally representative data.
METHODS
CRC cases were identified from San Francisco General Hospital (SFGH) and the Surveillance Epidemiology and End Results (SEER) database.
RESULTS
Fifty-five percent of the SFGH cohort presented with advanced disease, compared with 44% of the SEER cohort. Increased risk of advanced stage at presentation at SFGH compared with SEER was most evident among blacks and Asians. There was weak evidence for worse survival at SFGH compared with SEER overall. This varied by race with poorer survival at SFGH among whites and possibly blacks but some evidence for better survival among Asians. Among CRC patients at SFGH, Asians and Hispanics had better survival than whites and blacks. At SFGH, 44% had a diagnosis of CRC within 1 year of establishing care there. Of those who had established care at SFGH for at least 1 year, only 22% had exposure to CRC screening tests.
CONCLUSIONS
These findings allow examination of CRC presentation by ethnicity in vulnerable populations and identify areas where access and utilization of CRC screening can be improved.