Biomedical Research

Research Article - Biomedical Research (2017) Volume 28, Issue 22

Risk factors of colorectal cancer and its clinical epidemiological study

Yi Liu1, Wen bin Ding2, Chengqiu Yan1, Han Bao1, Kai Li3, Cheng Wang4*

1Department of Anorectal, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin Province, China

2Department of Endoscopy, The Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin Province, China

3Department of Surgery, Dehui People’s Hospital, Changchun, Jilin Province, China

4Fourth Department of Internal Medicine, Jilin Tumor Hospital, Changchun, Jilin Province, China

*Corresponding Author:
Cheng Wang
Fourth Department of Internal Medicine
Jilin Tumor Hospital
Jilin Province, China

Accepted date: October 16, 2017

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Abstract

Objective: To explore risk factors of colorectal cancer and its clinical epidemiological study.

Methods: This study analysed clinical data of 1860 colorectal cancer patients retrospectively, its epidemiological characteristics, compared them with 1725 non-tumor patients, risk factors which caused colorectal cancer.

Results: There were significant differences in sex (χ2=204.404, P<0.05), age (χ2=-0.208, P<0.05), years (χ2=4.254, P<0.05), primary focus location (χ2=73.050, P<0.05) and pathological type distribution (χ2=22.066, P<0.05) of colorectal patients; there were significant differences in basic diseases (χ2=35.623, P<0.05; χ2=13.359, P<0.05), colorectal cancer family history (χ2=18.628, P<0.05), cholecystectomy history (χ2=27.420, P<0.05), appendectomy between patients in colorectal group and the control group (P<0.05), which given single factor and multiple factors logistic analysis, it was found that diabetes, hypertension, colorectal cancer family history and appendectomy all can be risk factors which induced colorectal cancer. Diabetes (OR 95% CI=1.019-2.299, P=0.039) and colorectal cancer family history (OR 95% CI=3.769-21.380, P<0.001) were the main risk factors which induced colorectal cancer.

Conclusion: The high group of colorectal cancer are male. The onset age is mainly middle and old age group. Primary focal location is mainly in rectum. Pathological type is canal adenocarcinoma mostly. Diabetes and colorectal cancer family history are main risk factors which induced colorectal cancer.

Keywords

Colorectal cancer, Risk factors, Epidemiological characteristics.

Introduction

Colorectal Cancer (CRC) is one common malignant tumor with relative high incidence rate and death rate around the world. CRC is one of the most frequent cancers in the world and a significant cause of human mortality and the second and third leading cause of cancer-related deaths in males and females, respectively, in the United States [1,2]. Poor prognosis and consequences of its metastatic spread make CRC the second most common cause of cancer-related deaths in western countries [3]. Increasing evidence suggests a pivotal role for intestinal microbiota in the development of colitis and CRC [4,5]. For this purpose, the research of the etiologies and risk factors of colorectal adenomas have taken on broader significance. Clinical data of 1860 colorectal cancer patients for four years in our hospital are given retrospective analysis. This study explores its clinical epidemiological characteristics and risk factors.

Materials and Methods

General data

1860 colorectal cancer patients from January, 2010 to January, 2014 were selected as study objects. All patients met relevant diagnostic criteria of colorectal cancer in rectal cancer diagnostic and treatment cancer application guide [5] by American colorectal RCPSC, diagnosed by routine iconography and histopathological examination. There were 1148 male patients and 712 female patients. The age was from 16 to 93 y old. The average year was 59.26 ± 4.58 y old. 1725 non-tumor patients in rectal anal surgery of our hospital at the same time were selected as the control group. There were 1067 male patients and 658 female patients. The age was from 17 to 85 y old. The average age was 56.81 ± 4.60 y old. There were no statistical differences in sex, age etc. of patients in two groups (P>0.05), it had comparability. This research was approved by the Ethical Committee of Xinjiang Medical University according to the declaration of Helsinki promulgated in 1964 as amended in 1996, the approval number is 2010004.

Methods

This study investigated clinical data of colorectal cancer patients, analysed epidemiological characteristics, compared the differences between colorectal cancer patients and relevant factors in the control group, analysed factors with statistical differences by single factor and multiple factors analysis, explore risk factors which induced colorectal cancer [7].

Statistical analysis

This study used SPSS 19.0 software to do statistical analysis. Measurement data were represented by mean and standard deviation (x̄ ± s). Comparison between groups, before and after treatment was given t-test. Enumeration data were represented by constituent ratio and given χ2 test. Single factor was given four-fold table χ2 test. Logistic regression analysis was given maximum likelihood variables step by step, which brought into analysis. Then to calculate OR and CI.

Results

Epidemiological characteristics analysis of colorectal cancer patients

There were significant differences in sex, age, years, primary focal location and pathological type distribution in colorectal patients (P<0.05). The high group of colorectal cancer are male. The onset age is mainly middle and old age group. Primary focal location is mainly in rectum. Pathological type is canal adenocarcinoma mostly. In recent years, the incidence rate of it increases year after year (Table 1).

Items Cases % χ2 P
Sex     204.404 <0.001
Male 1148 61.72    
Female 712 38.28    
Age/y old     -0.208 0.040
= 29 55 2.96    
30~39 178 9.57    
40~49 287 15.43    
50~59 483 25.97    
60~69 447 24.03    
70~79 323 17.37    
= 80 87 4.68    
Year/year     4.254 0.039
2010 274 14.73    
2011 318 17.10    
2012 367 19.73    
2013 411 22.10    
2014 490 26.34    
Tumor type     3.135 0.077
Colon cancer 903 48.55    
Rectal cancer 957 51.45    
Primary focal location     73.050 <0.001
Ascending colon including splenic flexure of colon) 246 13.23    
Transverse colon (including splenic flexure of colon) 219 11.77    
Descending colon 75 4.03    
Sigmoid colon 363 19.52    
rectum 957 51.45    
Blood type     3.094 0.377
A type 470 25.27    
B type 443 23.82    
O type 844 45.38    
AB type 103 5.54    
Pathological type     22.066 <0.001
Canal adenocarcinoma 1345 72.31    
Papillary adenocarcinoma 226 12.15    
canal papillary adenocarcinoma 57 3.06    
Mucous adenocarcinoma 197 10.59    
Signet-ring cell carcinoma 35 1.88    

Table 1: Epidemiological investigation of colorectal cancer patients.

Risk factors analysis of colorectal cancer

There were significant differences in basic diseases, colorectal cancer family history, cholecystectomy history, appendectomy between patients in colorectal group and the control group (P<0.05), seen in Table 2, which given single factor, it was found that diabetes, hypertension, colorectal cancer family history and appendectomy all can be risk factors which induced colorectal cancer, seen in Table 3. In multiple logistic regression analysis, in order to select risk factors from diabetes, hypertension, colorectal cancer family history and appendectomy, only diabetes (OR 95% CI=1.019-2.299, P=0.039) and colorectal cancer family history (OR 95% CI=3.769-21.380, P<0.001) were related to the presence of CRC (Table 4).

Relevant factors Colorectal cancer group (n=1860) The control group (n=1725) χ2/t P
Sex        
Male 1148 (61.72) 1067 (61.86) 0.007 0.934
Female 712 (38.28) 658 (38.14)    
Average age/years old 59.26 ± 4.58 56.81 ± 4.60 19.267 1.028
Blood type        
A type 470 (25.27) 393 (22.78) 3.027 0.082
B type 443 (23.82) 387 (22.43) 0.961 0.327
O type 844 (45.38) 786 (45.57) 0.013 0.910
AB type 103 (5.54) 159 (9.22) 17.899 0.052
Basic diseases        
Hypertension 189 (10.16) 84 (4.87) 35.623 <0.001
diabetes 95 (5.11) 47 (2.72) 13.359 <0.001
Colorectal cancer family history 49 (2.63) 13 (0.75) 18.628 <0.001
Cholecystectomy history 12 (0.65) 7 (0.41) 0.973 0.324
Appendectomy history 60 (3.23) 13 (0.75) 27.420 <0.001

Table 2: Comparison of relevant factor of patients in two groups.

Relevant factors Wald P OR 95% CI
diabetes 36.45 <0.001 4.967 2.951~8.358
hypertension 29.601 <0.001 0.524 0.415~0.661
Colorectal cancer family history 1.242 0.002 3.464 1.576~7.610
Cholecystectomy history 0.471 0.481 1.603 0.248~5.992
Appendectomy history 1.459 <0.001 4.307 2.015~9.201

Table 3: Single logistic analysis results of colorectal cancer.

Relevant factors Wald P OR 95% CI
diabetes 4.215 0.039 1.53 1.019~2.299
hypertension 0.051 0.817 0.958 0.670~1.369
Colorectal cancer family history 24.577 <0.001 8.977 3.769~21.380

Table 4: Multiple factors logistic results of colorectal cancer.

Discussion

Colorectal cancer is the third malignant tumor after lung cancer and breast cancer. Clinical incidence rate and death rate are relative high. To grasp its epidemiological characteristics and risk factors for benefiting screen and prevention of colorectal cancer [8].

Lots of reports at abroad, which show there are estrogen expression in tissue of colorectal tissue [9,10], the hormone level in young female high generally. So incidence rate of female lower than male [11]. Shiovitz et al. [12] study points out estrogen receptor in colorectal cancer tissue has positive correlations with progesterone receptor in quantitative experiment of rectal estrogen receptor and progesterone receptor, but it has no correlations with tumor malignant degree. Incidence rate of male colorectal cancer higher than female in this study, which is similar to study reports above. In this study, incidence rate of colon and rectum are 48.55% and 51.45% respectively, they are similar, which has great differences from study reports at abroad [13,14]. Incidence of colorectal cancer has relation with heritage, environment and diet etc. There are great differences between China and foreign countries above, which is the reason of causing great differences in report results at home and abroad [15,16]. From the year distribution, incidence rate of colorectal cancer increases year after year. The main reasons are improvement of life quality of people at home and changes of diet [17]. In addition, the development of clinical diagnostic technology, such as coloscope can find colorectal cancer earlier, it also one of important factors [18]. From onset age, colorectal cancer is mainly in middle and old age people, which provide important group for early screening, is benefit for precancerous lesions in early stage to avoid delaying treatment time [19]. This study compares colorectal cancer with relevant factors of noncolorectal cancer patients. The results show that diabetes and colorectal cancer family were the risk factors of CRC. Some studies are similar to our results. Li et al. [20] reported that preexisting diabetes mellitus in CRC patients is severely associated with the worse overall survival. And a cohort study showed that the risk of CRC mortality is significantly increased in both sexes and women with diabetes [21]. For relevant risk factors of colorectal cancer above, this can guide early general surgery, screen and prevention of colorectal cancer.

In conclusion, colorectal cancer has significant epidemiological characteristics. Diabetes and colorectal cancer are then main risk factors which induce colorectal cancer. Medium-elderly men, patients with diabetes and colorectal cancer family history are included into important group of general survey and screening, which has great significance on early discovery and treatment of colorectal cancer.

References