Stanley J Dudrick Department of Surgery, Saint Mary's Hospital, Waterbury, Connecticut 06706, USA.
J Surg Res. 2011 Jan;165(1):15-8. doi: 10.1016/j.jss.2010.08.054. Epub 2010 Sep 26.
The incidence of colorectal cancer (CRC) in young adults is rising, and young age is a predictor of poor survival. The purpose of this study was to examine factors leading to increased mortality in patients ≤ 50 years of age, and to examine this population for characteristics that could lead to benefit from CRC screening.
Charts of patients 50 years of age and under, diagnosed with CRC from 1998 through 2007, at our community teaching hospital, were reviewed retrospectively. Demographics, social and family history, staging, treatment and death were evaluated. Mann Whitney, Fisher Exact, and χ(2) tests were used with P <0.05 considered statistically significant.
Forty-five young patients with CRC were identified. Twenty-five patients were female and 20 male; the mean age was 43.6 y. Most patients presented with rectal bleeding. Right-sided cancers had a higher presenting stage (P < 0.05). Men had both a higher presenting stage (P = 0.35) and a higher incidence of smoking compared with women (P = 0.001). Female patients were more likely to have left-sided CRC (65%) compared with men (35%). Ninety-six percent of patients underwent surgical resection; 14 patients died.
CRC in young adults is not common, but is often advanced when discovered. Diagnostic efforts should be aggressive in young patients who have rectal bleeding, especially young male smokers. Sigmoidoscopy is not adequate for comprehensive diagnosis of CRC in young patients, as the majority have right-sided colon cancers, which often result in subsequent presentation of the disease at a higher stage, risk, and mortality rate.
结直肠癌（CRC）在年轻人中的发病率正在上升，而年龄较轻是预后不良的预测因素。本研究的目的是探讨导致 50 岁以下患者死亡率增加的因素，并研究这一人群是否存在可能受益于 CRC 筛查的特征。
回顾性分析了我院社区教学医院 1998 年至 2007 年间诊断为 CRC 的 50 岁以下患者的病历。评估了人口统计学、社会和家族史、分期、治疗和死亡情况。采用 Mann-Whitney、Fisher 确切检验和 χ(2)检验，P<0.05 认为有统计学意义。
共确定了 45 例年轻 CRC 患者。25 例为女性，20 例为男性；平均年龄为 43.6 岁。大多数患者表现为直肠出血。右侧癌症的首发期更高（P<0.05）。与女性相比，男性首发期更高（P=0.35），且吸烟率更高（P=0.001）。与男性相比，女性更有可能患有左侧 CRC（65%比 35%）。96%的患者接受了手术切除；14 例患者死亡。
年轻成人 CRC 并不常见，但发现时往往已处于晚期。对于有直肠出血的年轻患者，应积极进行诊断，尤其是年轻的男性吸烟者。乙状结肠镜检查不能充分诊断年轻患者的 CRC，因为大多数患者有右侧结肠癌，这往往导致疾病在更高的分期、风险和死亡率下出现。
