根据记录,结直肠癌患者的生存率逐年增长。此增长可归功于外科手术技术、新辅助疗法和辅助疗法的更广泛使用以及无症状个体的筛查。
结直肠癌的预后取决于疾病的诊断时的分期。约一半有症状的患者被确诊患有晚期局限(III 期)或转移性疾病(IV 期)。[80]Heresbach D, Manfredi S, D'halluin PN, et al. Review in depth and meta-analysis of controlled trials on colorectal cancer screening by faecal occult blood test. Eur J Gastroenterol Hepatol. 2006;18:427-433.http://www.ncbi.nlm.nih.gov/pubmed/16538116?tool=bestpractice.com[81]Burch JA, Soares-Weiser K, St John DJ, et al. Diagnostic accuracy of faecal occult blood tests used in screening for colorectal cancer: a systematic review. J Med Screen. 2007;14:132-137.http://journals.sagepub.com/doi/abs/10.1258/096914107782066220?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&http://www.ncbi.nlm.nih.gov/pubmed/17925085?tool=bestpractice.com[210]O'Connell JB, Maggard MA, Ko CY. Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging. J Natl Cancer Inst. 2004;96:1420-1425.http://jnci.oxfordjournals.org/cgi/reprint/96/19/1420http://www.ncbi.nlm.nih.gov/pubmed/15467030?tool=bestpractice.com 与此相反,经筛查发现的癌症通常是更早期的疾病(大多数为 I-II 期)。[80]Heresbach D, Manfredi S, D'halluin PN, et al. Review in depth and meta-analysis of controlled trials on colorectal cancer screening by faecal occult blood test. Eur J Gastroenterol Hepatol. 2006;18:427-433.http://www.ncbi.nlm.nih.gov/pubmed/16538116?tool=bestpractice.com[81]Burch JA, Soares-Weiser K, St John DJ, et al. Diagnostic accuracy of faecal occult blood tests used in screening for colorectal cancer: a systematic review. J Med Screen. 2007;14:132-137.http://journals.sagepub.com/doi/abs/10.1258/096914107782066220?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&http://www.ncbi.nlm.nih.gov/pubmed/17925085?tool=bestpractice.com 直肠癌生存率也因国家而异。在欧洲,英国、丹麦和东欧国家的结肠癌 5 年生存率比欧洲 50% 的平均生存率低。[211]Coleman MP, Gatta G, Verdecchia A, et al. EUROCARE-3 summary: cancer survival in Europe at the end of the 20th century. Ann Oncol. 2003;14:128-146.http://www.ncbi.nlm.nih.gov/pubmed/14684503?tool=bestpractice.com EUROCARE 数据分析表明,英国的生存率较低可归因于患者则就诊及诊断时疾病已为较晚期,而非同分期的治疗不佳。[212]Gatta G, Capocaccia R, Sant M, et al. Understanding variations in survival for colorectal cancer in Europe: a EUROCARE high resolution study. Gut. 2000;47:533-538.http://gut.bmj.com/content/47/4/533.longhttp://www.ncbi.nlm.nih.gov/pubmed/10986214?tool=bestpractice.com
I 期结直肠癌的 5 年总生存率是 93%-97%,II 期结直肠癌的 5 年总生存率是 72%-85%,III 期结直肠癌的 5 年总生存率是 44%-83%(取决于淋巴结累及),IV 期结直肠癌的 5 年总生存率是<8%。[213]Kerr J, Engel J, Eckel R, et al. Survival for rectal cancer patients and international comparisons. Ann Oncol. 2005;16:664-672.http://annonc.oxfordjournals.org/cgi/content/full/16/4/664http://www.ncbi.nlm.nih.gov/pubmed/15734777?tool=bestpractice.com[214]Gill S, Blackstock AW, Goldberg RM. Colorectal cancer. Mayo Clin Proc. 2007;82:114-129.http://www.ncbi.nlm.nih.gov/pubmed/17285793?tool=bestpractice.com