Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany.
BMC Cancer. 2010 Dec 21;10:688. doi: 10.1186/1471-2407-10-688.
Old age at diagnosis is associated with poor survival in colorectal cancer (CRC) for unknown reasons. Recent data show that colonoscopy is efficient in preventing left-sided cancers only. We examine the association of Tumor Node Metastasis (TNM) classes with diagnostic age and patient characteristics.
The Swedish Family-Cancer Database has data on TNM classes on 6,105 CRC adenocarcinoma patients. Ordinal logistic regression analysis was performed to model tumor characteristics according to age at diagnosis, tumor localization, gender, socioeconomic status, medical region and family history. The results were compared to results from survival analysis.
The only parameters systematically associated with TNM classes were age and tumor localization. Young age at diagnosis was a risk factor for aggressive CRC, according to stage, N and M with odds ratios (ORs) ranging from 1.80 to 1.93 for diagnosis before age 50 years compared to diagnosis at 80+ years. All tumor characteristics, particularly T, were worse for colon compared to rectal tumors. Right-sided tumors showed worse characteristics for all classifiers but M. The survival analysis on patients diagnosed since 2000 showed a hazard ratio of 0.55 for diagnosis before age 50 years compared to diagnosis at over 80 years and a modestly better prognosis for left-sided compared to right-sided tumors.
The results showed systematically more aggressive tumors in young compared to old patients. The poorer survival of old patients in colon cancer was not related to the available tumor characteristics. However, these partially agreed with the limited colonoscopic success with right-sided tumors.
由于未知原因，结直肠癌（CRC）患者的诊断年龄越大，生存状况越差。最近的数据表明，结肠镜检查仅能有效地预防左侧结肠癌。我们研究了肿瘤淋巴结转移（TNM）分期与诊断年龄和患者特征的关系。
瑞典家族癌症数据库（Swedish Family-Cancer Database）拥有 6105 例结直肠腺癌患者的 TNM 分期数据。我们采用有序逻辑回归分析，根据诊断时的年龄、肿瘤部位、性别、社会经济状况、医疗区域和家族史，对肿瘤特征进行建模。将结果与生存分析进行比较。
唯一与 TNM 分期系统相关的参数是年龄和肿瘤部位。年轻的诊断年龄是侵袭性 CRC 的危险因素，根据分期、N 和 M，与 80 岁以上诊断相比，50 岁以下诊断的优势比（ORs）范围为 1.80 至 1.93。所有肿瘤特征，尤其是 T 期，对于结肠癌均比直肠癌更差。与直肠癌相比，右半结肠癌的所有分类器特征（尤其是 M）都更差。对 2000 年后诊断的患者进行生存分析显示，50 岁以下诊断的风险比为 0.55，而 80 岁以上诊断的风险比为 0.55，且左侧肿瘤的预后略优于右侧肿瘤。
结果显示，年轻患者的肿瘤比老年患者更具侵袭性。老年患者结肠癌预后较差与现有肿瘤特征无关。然而，这与结肠镜检查对右侧肿瘤的有限成功率部分一致。
