Josip Juraj Strossmayer University of Osijek. Faculty of Medicine Osijek.
Abstract
Cilj istraživanja: Usporediti udio patoloških nalaza (naprednih adenoma i karcinoma) ispitanika NP-a s nalazima pacijenata koji su kolonoskopski pregled obavili ambulantnim putem, s posebnim osvrtom na udio rizičnih čimbenika za nastanak bolesti u obje skupine. Nacrt studije: Istraživanje slučajeva i kontrola Ispitanici i metode: Istraživanje je provedeno u Osječko-baranjskoj županiji (OBŽ), od prosinca 2013. do srpnja 2017. godine. Skupinu slučajeva činili su sudionici Nacionalnoga programa otkrivanja raka debeloga crijeva (NP), dobi od 50 - 74 godine s patohistološkim nalazima naprednih adenoma i karcinoma. Kontrolnu skupinu činili su ambulantni pacijenti koji su kolonoskopski pregled obavili redovnim putem, zbog prisutnih simptoma. Prema zadanim kriterijima uparivanja pronašli smo 90 osoba istih karakteristika koje su se mogle uspoređivati s osobama iz našega uzorka (spol, dob te vremenski period obavljanja kolonoskopskoga pregleda). Podaci su prikupljani iz anketnoga upitnika sudionika NP-a, a podaci ambulantnih pacijenta prikupljeni su iz kartona LOM-a. Analizirani su kolonoskopski i patohistološki nalazi ispitanika obje skupine. Rezultati: Rezultati analize rizičnih čimbenika pokazali su da je među sudionicima NP-a značajno manji udio pušača (P = 0,03) te je značajno manja količina konzumiranih cigareta dnevno (P = 0,02). Sudionici NP-a u statistički značajno većem postotku konzumiraju alkohol (P = 0,04), ali manju dnevnu količinu (P = 0,06) u usporedbi s ambulantnim pacijentima. Muškarci u značajno većem postotku konzumiraju alkohol (P < 0,001). Ambulantni pacijenti u značajno su većem postotku neaktivni (P = 0,04). Podjednak je postotak ispitanika koji imaju dijagnosticiran adenom, odnosno karcinom, i konzumiraju alkohol (P = 0,92), cigarete (P = 0,16), razlike nema niti po pitanju tjelesne aktivnosti (P = 0,76). Najčešća dijagnoza istraživanja je tubularni adenom, prisutna kod 53,3 % ispitanika. Prema skupinama, kod sudionika NP-a značajno je češća dijagnoza tubularni adenom (P < 0,001), a hemoroidi su se značajno češće javili kod ambulantnih pacijenata (P < 0,001). Najčešći simptom istraživanja je „krv u stolici“, prisutan kod 23,3 % ispitanika. Zaključak: Ambulantni pacijenti u značajno većem postotku imaju prisutne rizične čimbenike, u odnosu na sudionike NP-a. Nije otkrivena značajna povezanost dijagnoza kolorektalnih adenoma i karcinoma s promatranim ponašajnim čimbenicima rizika.Aim: The aim of this study was to compare the proportion of pathological findings (advanced adenomas and cancers) of the participants in the National Programme (NP) with the findings obtained in patients who underwent colonoscopy in outpatient clinic, taking specifically into account the proportion of risk factors for desase development present in both groups of patients. Study design: Case study and control group Subjects and methods: The study was carried out in Osijek – Baranja County (OBC), from December 2013 to July 2017. The examined subjects included the participants of the National Programme for Early Detection of Colorectal Cancer (NP) in the 50-74 age range who had pathohistological findings of advanced adenomas and cancers and the control group. The control group consisted of patients referred to outpatient clinic for colonoscopy due to presence of symptoms. According to pre-set criteria (gender, age and when the colonoscopy was performed), there were 90 subjects in the control group having the same characteristics, who were compared with the subjects from the NP sample group. The data for the NP particiants were taken from the NP questionnaire, while the data for the outpatients were taken from patients' medical records. Colonoscopy and pathohistological results were analysed for both groups of subjects. Results: Risk factors analysis showed that the proportion of smokers was significantly lower among the NP participants (P=0.03) than in the outpatients. Also, the number of cigarettes consumed daily was significantly lower (P=0.02) in this group. However, significantly higher percentage of the NP participants consumed alcohol (P=0.04), although in smaller daily amounts (P=0.06) in comparison to outpatients. Significantly higher percentage of men consumed alcohol (P<0.001), while significantly higher percentage of outpatients was inactive (P=0.04). Approximately the same percentage of subjects with diagnosed adenomas or cancers consumed alcohol (P=0.92) and cigarettes (P=0.16). The results were similar regarding physical activity in both groups (P=0.76). The most common diagnosis in the research was tubular adenoma, in 53.3 % of subjects. However, tubular adenoma was significantly more commonly diagnosed in the NP participants (P=0.001), while hemorrhoids were more common in outpatients (P<0.001). Blood in stool was the most common symptom in the research, evident in 23.3 % of subjects. Conclusion: Risk factors were present in outpatients in significantly higher percentage than in NP participants. There was no significant correlation between colorectal adenoma and cancer diagnoses and analysed behavioral risk factors
