Alici Süleyman, Aykan N Faruk, Sakar Burak, Bulutlar Gulistan, Kaytan Esra, Topuz Erkan
Institute of Oncology, University of Istanbul, Istanbul, Turkey.
Tohoku J Exp Med. 2003 Feb;199(2):85-93. doi: 10.1620/tjem.199.85.
Colorectal cancer is predominantly a disease of the elderly population, but this disease is unusual in patients 40 years of age or under, and controversy persists as to prognosis in this subset of patients. The aim of this study was to determine the clinicopathologic features and their impact on patients survival of colorectal cancer in patients aged 40 years or younger, and to compare them with those of older patients. The records of 466 patients with non-metastatic colorectal adenocarcinoma who were referred between 1991 and 1999 to the University of Istanbul, Institute of Oncology, following curative surgery were retrospectively analysed. The clinicopathologic features of 84 (18%) colorectal cancers (group A; male:female ratio 48:36) which occurred in patients aged 40 years or younger were compared with 382 colorectal cancers in older patients (group B; male:female ratio 194:188). Patient gender, performance status, T stage, N stage, TNM stage, histologic grade, location of tumor, lymphatic invasion, serum levels of LDH and CEA, and survival rates were compared as prognostic factors. There was no statistically significant difference between group A and group B with respect to patient gender, performance status, T stage, N stage, TNM stage, histologic grade, location of tumor, serum levels of LDH and CEA, and survival rates of colorectal cancers. The proportion of lymphatic invasion was present in 27% of patients in group A vs. 12% in group B. With median follow-up of 69 months, the overall 5-year survival rate was 61% in group A and 56% in group B. In the univariate survival analysis according to age groups (group A and B), advanced TNM stage, location of rectal tumor, presence of lymphatic invasion, and presence of high serum LDH and CEA levels are predictors of poorer survival in young patients with colorectal cancer. In the Cox-Regression analysis, location of tumor and TNM stage were determined as independent prognostic factors for survival. This study revealed no difference in clinicopathologic characteristics in patients with colorectal cancer aged 40 years or younger compared with those aged above 40 years. However, in patients aged 40 years or younger, distal location of tumor and advanced stage should be considered as poor prognostic factors for overall survival.
结直肠癌主要是一种老年人群的疾病，但在40岁及以下的患者中这种疾病并不常见，对于这一亚组患者的预后仍存在争议。本研究的目的是确定40岁及以下结直肠癌患者的临床病理特征及其对患者生存的影响，并将其与老年患者进行比较。对1991年至1999年间因根治性手术转诊至伊斯坦布尔大学肿瘤研究所的466例非转移性结直肠腺癌患者的记录进行了回顾性分析。将40岁及以下患者中发生的84例（18%）结直肠癌（A组；男女比例为48:36）的临床病理特征与老年患者中的382例结直肠癌（B组；男女比例为194:188）进行比较。比较患者性别、体能状态、T分期、N分期、TNM分期、组织学分级、肿瘤位置、淋巴浸润、血清LDH和CEA水平以及生存率作为预后因素。A组和B组在患者性别、体能状态、T分期、N分期、TNM分期、组织学分级、肿瘤位置、血清LDH和CEA水平以及结直肠癌生存率方面无统计学显著差异。A组27%的患者存在淋巴浸润，而B组为12%。中位随访69个月，A组的总体5年生存率为61%，B组为56%。在根据年龄组（A组和B组）进行的单因素生存分析中，晚期TNM分期、直肠肿瘤位置、淋巴浸润的存在以及高血清LDH和CEA水平的存在是年轻结直肠癌患者生存较差的预测因素。在Cox回归分析中，肿瘤位置和TNM分期被确定为生存的独立预后因素。本研究显示，40岁及以下结直肠癌患者与40岁以上患者的临床病理特征无差异。然而，在40岁及以下的患者中，肿瘤的远端位置和晚期应被视为总体生存的不良预后因素。
