Læknablaðið - 15.06.1996, Blaðsíða 24

450
LÆKNABLAÐIÐ 1996; 82
Töf á greiningu ristilkrabbameina,
tengsl við stigun og lífshorfur
Afturskyggn rannsókn frá
Landspítalanum 1980-1892
Sigríöur Másdóttir2’, Tómas Guðbjartsson11, Tómas Jónsson11, Jónas Magnússon11
Másdóttir S, Guðbjartsson T, Jónsson T, Magnús-
son J
Delay in the diagnosis of colon cancer, associated
with staging and prognosis. A retrospective study
from Landspítalinn University Hospital 1980-1992
Læknablaðið 1996; 82: 450-9
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 Landspítalinn University Hospi-
tal, 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 surgica! 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 lev-
el. Patients were staged according to Duke’s classifi-
cation, 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 anae-
Frá '’handlækningadeild Landspítalans, 2)læknadeild Há-
skóla (slands. Fyrirspurnir, bréfaskipti: Jónas Magnússon
handlækningadeild Landspítalans, 101 Reykjavík.
Lykilorð: Ristilkrabbamein á Landspítalanum, afturskyggn
rannsókn, einkenni, töf á greiningu, stigun, lifshorfur.
mia, bloody stools and abdominal pain. Of the pa-
tients 38% suffered delay in diagnosis and treatment
of more than three months from the onset of symp-
toms, 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 stag-
ing 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 pa-
tients with colon cancer at Landspítalinn 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.
Ágrip
Inngangur: Töf verður oft á greiningu ristil-
krabbameins 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. At-