First Presentation With "Symptoms And/or Elevated Tumor Markers" Clinical Features Of Colorectal Tumors

Background and objective:Colorectal cancer is one of the major causes of global health burden and cancer-related deaths,and colonoscopy(combined with pathology)is the gold standard for colorectal cancer screening,but the participation rate of colonoscopy in colorectal cancer screening in China is low,mainly due to its invasive nature and the need for adequate bowel preparation.This study analyses and summarises the incidence and clinical characteristics of colorectal tumors first diagnosed by "symptoms and/or elevated tumor markers",intending to identify precancerous lesions at an early stage,improve the diagnosis and treatment rate of colorectal tumors,improve patients’ prognosis,and enhancing their quality of life.Methods:A total of 758 patients with complete colonoscopic findings and colorectal pathological examination were retrospectively analyzed from January 1,2021,to December 31,2021,who were hospitalized in the Department of Geriatrics of Qilu Hospital of Shandong University for"symptoms and/or elevated tumor markers",including 236 patients with colorectal tumors(A total of 215 cases of pre-cancerous colorectal lesions and early cancer,21 cases of colorectal cancer).The biological data,clinical data,and endoscopic and histopathological data were collected by excluding those with incomplete relevant data.Inclusion criteria for colorectal tumor patients:(1)All included cases should have undergone colonoscopy and pathological examination and be pathologically confirmed as colorectal precancerous lesions(colorectal adenoma,colorectal serrated polyp)and early carcinoma,colorectal cancer;(2)The biological data,clinical data,endoscopic and histopathological data,etc.were complete.Exclusion criteria:(1)exclude those with other malignant tumors at the same time;(2)incomplete biological data,clinical data,endoscopic and histopathological data,etc.In this study,patients with colorectal tumors were divided into 2 groups,namely the colorectal cancer group and the colorectal precancer and early cancer group,and then the latter was divided into 2 subgroups based on the grade of intraepithelial neoplasia,namely low-grade intraepithelial neoplasia group and high-grade intraepithelial neoplasia group.Excel 2016 and SPSS 26.0 software were applied for data processing to analyze and summarise the incidence and clinical characteristics of colorectal tumors.Results:A total of 758 patients were finally included in this study,including 236 patients with colorectal tumors.Excluding those with other malignancies at the same time,a total of 214 patients with colorectal tumors were included,18(8.41%)in the colorectal cancer group,24(11.21%)in the high-grade intraepithelial neoplasia group(including intramucosal cancer)and 164(76.64%)in the low-grade intraepithelial neoplasia group,and 8(3.74%)in the histopathological group without classification of intraepithelial neoplasia grade.The differences between the three groups in terms of age(P=0.005),change in bowel habits(P=0.015),bleeding symptoms(P<0.001),abdominal discomfort(P=0.006),anal cramping(P=0.010),FIT(P<0.001),HGB(P=0.002),ALB(P=0.039)and CEA(P=0.011)were statistically significant.Logistic regression analysis suggested that weakly positive and positive FIT(OR=4.147,P<0.001)and age(>75 years)(OR=7.869,P=0.013)were independent risk factors for developing colorectal cancer and early cancer.Conclusions:(1)Colorectal tumors account for a certain proportion of patients first diagnosed with"symptoms and/or elevated tumor markers".(2)Patients with colorectal tumors differed in terms of age,change in bowel habits,bleeding symptoms,abdominal discomfort,anal cramping,FIT,HGB,ALB,and CEA.(3)Weakly positive and positive FIT and age>75 years were independent risk factors for developing colorectal cancer and early cancer.