The comparison of the risk factors and clinical manifestations of proximal and distal colorectal cancer.
OBJECTIVE
Colorectal cancers in the proximal or distal site have distinct clinical characteristics. In this study, the authors compared the risk factors of proximal and distal colorectal cancer.


METHODS
A 16-page questionnaire was administered to 529 patients with colorectal cancer before operation. Cancers were classified as proximal or distal relative to the splenic flexure. Of these 529 patients, 6 patients were excluded because of the presence of synchronous colorectal cancers. Data of the 523 patients were analyzed.


RESULTS
Total numbers of proximal and distal cancers were 123 and 400. The proportion of patients with Type 2 diabetes was significantly higher for distal cancer (P = 0.034), whereas a greater proportion of patients with proximal cancer had a gallstone history (P = 0.005). Multivariate analysis revealed Type 2 diabetes to be a risk factor for distal colorectal cancer (P = 0.027) and cholelithiasis to be a risk factor for proximal cancer (P = 0.049). The odds ratio for distal colorectal cancer among males with Type 2 diabetes was 4.1 (95 percent confidence interval, 1.4-12.1). On the other hand, a gallstone history was more associated with proximal colon cancer, especially in females (odds ratio = 5.5; 95 percent confidence interval, 1.4-20.9).


CONCLUSIONS
A comparison of the risk factors of proximal and distal colorectal cancer showed that Type 2 diabetes is associated with distal colorectal cancer in males and that cholelithiasis is associated with proximal colon cancer in females.
Oh
Sung-Wook
SW
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Dong 50, Gangnam-gu, Seoul, South Korea.
Kim
Young-Ho
YH
Choi
Yong Sung
YS
Chang
Dong Kyung
DK
Son
Hee Jung
HJ
Rhee
Poong-Lyul
PL
Kim
Jae J
JJ
Rhee
Jong Chul
JC
Yun
Seong-Hyeon
SH
Lee
Woo-Yong
WY
Chun
Ho-Kyung
HK
Kim
Duk-Hwan
DH
Shim
Sang Goon
SG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000209:etiology / Q000235:genetics / Q000473:pathology*; D015897:Comorbidity; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D011795:Surveys and Questionnaires