Lin Jen-Tsun, Wang Wei-Shu, Yen Chueh-Chuan, Liu Jin-Hwang, Yang Mu-Hua, Chao Ta-Chon, Chen Po-Min, Chiou Tzeon-Jye
Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital, #201 Sec. 2 Shi-Pai Road, Shi-Pai, Taipei 112, Taiwan.
J Gastroenterol Hepatol. 2005 Jun;20(6):900-5. doi: 10.1111/j.1440-1746.2005.03893.x.
Colorectal carcinoma in patients under 40 years of age usually has a poor prognosis. Controversies still exist regarding the features and the prognosis of colorectal cancer in young patients.
The records of 45 patients with histologically confirmed colorectal carcinoma treated between 1992 and 2002 at the Division of Oncology at Taipei Veterans General Hospital were reviewed. The relevance of sex, duration of symptoms, tumor site, histological type, lymph node involvement, Karnofsky performance status (KPS), carcinoembryonic antigen (CEA) and lactate dehydrogenase (LDH) levels at the diagnosis and tumor stage to overall survival (OS) were determined by univariate analysis, and their independent significance were tested by multivariate analysis.
Most patients presented with an advanced tumor stage (24% Dukes' C and 66% Dukes' D). Colon carcinoma constituted 76% of the colorectal tumors. Family history was present in two patients and did not affect the OS. Two patients were found to have colon carcinoma during pregnancy. The 5-year survival rate in patients with Stage B, C, and D were 25, 16 and 0%, respectively. With aggressive treatment, patients with early stage carcinoma achieved longer survival. Eleven patients received resection of metastatic carcinoma of the liver, lung and ovary. Adjuvant chemotherapy with irinotecan/5-fluorouracil-based chemotherapy seemed to improve the OS in such patients, though the OS was still poorer than in patients with early stage tumors. In univariate analysis, KPS (P = 0.0001), lymph node involvement (P = 0.0024), CEA (P = 0.0423) and LDH levels (P = 0.0126) at the diagnosis and tumor stage (P = 0.0122) proved to be significant predictors of overall survival. Multivariate analyses revealed that KPS > or =70% (P = 0.007) and normal LDH levels at diagnosis (P = 0.004) were predictive of overall survival in this population.
The present study shows that performance status and preoperative LDH levels were the major determinants for survival in patients with colorectal carcinoma under 40 years of age and the present series also suggests that surgical resection of metastatic colorectal carcinoma followed by adjuvant chemotherapy might be beneficial in certain patients. The data also suggests that current treatment modalities for young patients with advanced colorectal cancer might not be effective and more effective therapeutic regimens might be needed. Thus, it is important for surgeons to recognize the potential for colorectal cancer in young patients and to take an aggressive approach to the diagnosis and early treatment of the disease.
40岁以下患者的结直肠癌通常预后较差。关于年轻患者结直肠癌的特征和预后仍存在争议。
回顾了1992年至2002年在台北荣民总医院肿瘤科接受治疗的45例经组织学确诊的结直肠癌患者的记录。通过单因素分析确定性别、症状持续时间、肿瘤部位、组织学类型、淋巴结受累情况、卡诺夫斯基功能状态（KPS）、诊断时癌胚抗原（CEA）和乳酸脱氢酶（LDH）水平以及肿瘤分期与总生存期（OS）的相关性，并通过多因素分析检验其独立意义。
大多数患者表现为晚期肿瘤分期（24%为杜克C期，66%为杜克D期）。结肠癌占结直肠肿瘤的76%。两名患者有家族史，但未影响总生存期。两名患者在怀孕期间被发现患有结肠癌。B期、C期和D期患者的5年生存率分别为25%、16%和0%。通过积极治疗，早期癌患者生存期更长。11例患者接受了肝、肺和卵巢转移癌切除术。基于伊立替康/5-氟尿嘧啶的辅助化疗似乎可改善此类患者的总生存期，尽管其总生存期仍比早期肿瘤患者差。在单因素分析中，诊断时的KPS（P = 0.00）、淋巴结受累情况（P = 0.0024）、CEA（P = 0.0423）和LDH水平（P = 0.0126）以及肿瘤分期（P = 0.0122）被证明是总生存期的重要预测因素。多因素分析显示，KPS≥70%（P = 0.007）和诊断时LDH水平正常（P = 0.004）可预测该人群的总生存期。
本研究表明，功能状态和术前LDH水平是40岁以下结直肠癌患者生存的主要决定因素，本系列研究还表明，转移性结直肠癌手术切除后辅助化疗可能对某些患者有益。数据还表明，目前针对年轻晚期结直肠癌患者的治疗方式可能无效，可能需要更有效的治疗方案。因此，外科医生认识到年轻患者患结直肠癌的可能性并积极诊断和早期治疗该疾病很重要。
