Department of Pediatric Oncology, King Hussein Cancer Center, Amman, Jordan.
Cancer. 2010 Feb 1;116(3):758-65. doi: 10.1002/cncr.24777.
Colorectal cancer is exceedingly rare in children and adolescents. Reports from small series indicate that poor prognostic factors are more common in children than in adults, resulting in worse outcome for the pediatric population.
The Surveillance, Epidemiology, and End Results database was searched for records of children/adolescents with colorectal cancer, and the features and outcomes were compared with those of adults.
From January 1973 through December 2005, only 159 children/adolescents (ages 4-20 years) were reported with a diagnosis of colorectal cancer. The most common sites of involvement were the rectum (27%) and the transverse colon (26%). Adenocarcinoma was the most common histotype in both adults and pediatric patients; however, children/adolescents had more unfavorable histotypes (ie, mucinous adenocarcinoma [22%] and signet ring cell carcinoma [18%]) when compared with adults (10% and 1%, respectively; P < .001). Poorly differentiated and undifferentiated tumors (grades III and IV, respectively) and distant stage were more common in children/adolescents (P < .001). The 5-year relative survival estimates in children/adolescents and adults were 40% +/- 4.2% and 60% +/- 0.10%, respectively, confirming a worse outcome in the pediatric age group (P < .001).
Children/adolescents represent a minority of patients with colorectal cancer and have high-risk features and worse outcome than adults. The small number of patients in this age group was an impediment to the development of meaningful clinical trials. Thus, the principles of management for adult colorectal cancer should be used in the treatment of children and adolescents.
结直肠癌在儿童和青少年中极为罕见。来自小系列的报告表明，儿童比成人更常见不良预后因素，导致儿科人群的结局更差。
检索监测、流行病学和最终结果数据库中儿童/青少年结直肠癌的记录，并将其特征和结局与成人进行比较。
1973 年 1 月至 2005 年 12 月，仅报告了 159 例儿童/青少年（4-20 岁）患有结直肠癌。最常见的受累部位是直肠（27%）和横结肠（26%）。腺癌是成人和儿科患者中最常见的组织学类型；然而，与成人（分别为 10%和 1%）相比，儿童/青少年的组织学类型更差（即黏液腺癌[22%]和印戒细胞癌[18%]）（P<0.001）。分化差和未分化肿瘤（分别为 III 级和 IV 级）和远处转移分期在儿童/青少年中更为常见（P<0.001）。儿童/青少年和成人的 5 年相对生存率估计值分别为 40%+/-4.2%和 60%+/-0.10%，证实儿科年龄组的结局更差（P<0.001）。
儿童/青少年是结直肠癌患者中的少数人群，具有高危特征和比成人更差的结局。该年龄段患者数量较少，阻碍了有意义的临床试验的开展。因此，成人结直肠癌的治疗原则应适用于儿童和青少年的治疗。
