Tawadros Patrick S, Paquette Ian M, Hanly Ann M, Mellgren Anders F, Rothenberger David A, Madoff Robert D
1 Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, Minnesota 2 Division of Colon and Rectal Surgery, University of Cincinnati, Cincinnati, Ohio 3 Center for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland 4 Division of Colon and Rectal Surgery, University of Illinois, Chicago, Illinois.
Dis Colon Rectum. 2015 May;58(5):474-8. doi: 10.1097/DCR.0000000000000318.
Overall, the incidence of colorectal cancer appears to be stable or diminishing. However, based on our practice pattern, we observed that the incidence of rectal cancer in patients under 40 is increasing and may be associated with a prominence of signet-ring cell histology.
The aim of this study was to verify the rising trend in rectal cancer in patients under 40 and describe the histology prominent in that cohort.
This is a retrospective cohort study.
We performed a retrospective cohort study of all patients diagnosed with rectal adenocarcinoma from 1980 to 2010 using the Surveillance, Epidemiology, and End Results cancer registry.
Rectal cancer incidence, histology, and associated staging characteristics were the primary outcomes measured.
Although the incidence of rectal cancer for all ages remained stable from 1980 to 2010, we observed an annual percent change of +3.6% in the incidence of rectal cancer in patients under 40. The prevalence of signet cell histology in patients under 40 was significantly greater than in patients over 40 (3% vs 0.87%, p < 0.01). A multivariate regression analysis revealed an adjusted odds ratio of 3.6 (95% CI, 2.6-5.1) for signet cell histology in rectal adenocarcinoma under age 40. Signet cell histology was also significantly associated with a more advanced stage at presentation, poorly differentiated tumor grade, and worse prognosis compared with mucinous and nonmucinous rectal adenocarcinoma.
The study was limited by its retrospective nature and the information available in the Surveillance, Epidemiology, and End Results database.
Despite a stable incidence of rectal cancer for all ages, the incidence in patients under 40 has quadrupled since 1980, and cancers in this group are 3.6 times more likely to have signet cell histology. Given the worse outcomes associated with signet cell histology, these data highlight a need for thorough evaluation of young patients with rectal symptoms.
总体而言，结直肠癌的发病率似乎趋于稳定或呈下降趋势。然而，根据我们的临床实践模式，我们观察到40岁以下患者的直肠癌发病率正在上升，且可能与印戒细胞组织学类型的显著增多有关。
本研究旨在验证40岁以下患者直肠癌发病率的上升趋势，并描述该队列中突出的组织学类型。
这是一项回顾性队列研究。
我们利用监测、流行病学和最终结果（SEER）癌症登记数据库，对1980年至2010年间所有诊断为直肠腺癌的患者进行了回顾性队列研究。
直肠癌发病率、组织学类型及相关分期特征是主要观察指标。
虽然1980年至2010年间各年龄段直肠癌的发病率保持稳定，但我们观察到40岁以下患者的直肠癌发病率年变化率为+3.6%。40岁以下患者印戒细胞组织学类型的患病率显著高于40岁以上患者（3%对0.87%，p<0.01）。多因素回归分析显示，40岁以下直肠腺癌中印戒细胞组织学类型的校正比值比为3.6（95%CI，2.6 - 5.1）。与黏液性和非黏液性直肠腺癌相比，印戒细胞组织学类型还与就诊时更晚期别、肿瘤低分化程度及更差的预后显著相关。
本研究受其回顾性性质以及SEER数据库中可用信息的限制。
尽管各年龄段直肠癌的发病率稳定，但自1980年以来，40岁以下患者的发病率增长了四倍，且该组癌症具有印戒细胞组织学类型的可能性是其他类型的3.6倍。鉴于印戒细胞组织学类型与更差的预后相关，这些数据凸显了对有直肠症状的年轻患者进行全面评估的必要性。
