Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin/St James' Hospital, Dublin 8, Ireland.
Dis Esophagus. 2011 Nov;24(8):560-8. doi: 10.1111/j.1442-2050.2011.01183.x. Epub 2011 Mar 8.
It is not known whether patients diagnosed with esophageal and junctional cancer aged younger than 50 years have a more aggressive disease phenotype and thus poorer outcomes following treatment. Prospectively maintained database records of all patients diagnosed with esophageal carcinoma (n= 2129) over a 20-year period (1990-2009) in a single institution were analyzed. Patients aged less than 50 years at diagnosis (n= 170) were compared with those over 50 years with respect to clinicopathological stage and oncological outcomes. There was a significantly greater proportion of male patients (77.4 vs. 64.7%) among the younger group (P= 0.001). Patients were more likely to be diagnosed with an esophagogastric junction tumor (P= 0.002) and to have symptoms for a longer period prior to diagnosis (24.0 vs. 17.8 weeks, P= 0.03) if they were aged less than 50 years old. There was no significant difference in clinicopathological staging including Tumor-Nodal-Metastasis (TNM) stage, differentiation, and lymphatic and perineural invasion other than a greater likelihood of venous invasion in the older group (P= 0.002). Younger patients were more likely to be treated with curative rather than palliative intent (66.9 vs. 51.1%, P < 0.001). The disease-specific survival of patients younger than 50 years treated with curative intent was significantly greater than older patients (median 35 vs. 21 months, P= 0.04), except for the subgroup of patients aged less than 35 years (n= 18) who have reduced survival. Multivariate analysis revealed independent factors related to the difference in survival included sex, age, advanced T stage, and nodal metastases (P < 0.05). A consistent proportion of esophageal cancer patients are diagnosed aged less than 50 years old over time (1990-2009). Few phenotypic tumor differences were noted between the groups. With an aggressive approach to management, survival is significantly greater than in the older cohort, although outcomes are poorer in those aged below 35 years.
目前尚不清楚年龄小于 50 岁的食管和食管胃交界部癌患者在接受治疗后是否具有更具侵袭性的疾病表型，从而导致更差的预后。分析了 20 年间（1990-2009 年）在单一机构中确诊的 2129 例食管癌患者的前瞻性数据库记录。将诊断时年龄小于 50 岁的患者（n=170）与年龄大于 50 岁的患者进行比较，比较其临床病理分期和肿瘤学结果。年轻组中男性患者比例明显更高（77.4%比 64.7%，P=0.001）。年轻组患者更可能被诊断为食管胃交界部肿瘤（P=0.002），且自诊断前出现症状的时间更长（24.0 周比 17.8 周，P=0.03）。两组在临床病理分期（包括肿瘤-淋巴结-转移分期、分化程度、淋巴管和神经周围侵犯）方面无显著差异，但老年组静脉侵犯的可能性更大（P=0.002）。年轻患者更可能接受根治性而非姑息性治疗（66.9%比 51.1%，P<0.001）。接受根治性治疗的年轻患者的疾病特异性生存率显著高于老年患者（中位 35 个月比 21 个月，P=0.04），但年龄小于 35 岁的患者亚组（n=18）除外，该亚组患者的生存率降低。多变量分析显示，与生存差异相关的独立因素包括性别、年龄、进展期 T 分期和淋巴结转移（P<0.05）。在过去的时间里，诊断时年龄小于 50 岁的食管癌患者比例始终保持一致（1990-2009 年）。两组之间很少有肿瘤表型差异。通过积极的治疗方法，患者的生存率显著高于老年组，但年龄小于 35 岁的患者预后较差。
