Haresh K P, Benson Rony, Mallick Supriya, Gupta Subhash, Sharma Dayanand, Pandey Rambha, Julka Pramod Kumar, Rath Goura Kishor
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
Clin Colorectal Cancer. 2016 Jun;15(2):e23-8. doi: 10.1016/j.clcc.2015.12.009. Epub 2015 Dec 29.
Carcinoma of the rectum is the fourth most common cancer in the world. The peak age of diagnosis is around the seventh decade. Rectal cancer presenting in those < 35 years old are very peculiar in that they present with adverse histologic features and more advanced stage compared with rectal cancer presenting in older patients.
We retrospectively evaluated the patient records of young patients with rectal cancer (aged < 35 years) treated in our unit at the All India Institute from 2007 to 2013.
A total of 60 young patients with rectal cancer were registered in our unit during the study period. A family history of cancer was present in 3 patients. The median age at presentation was 27.5 years (range, 15-34 years). The male-to-female ratio was 1.5:1. Of the 60 patients, 52 (86.6%) presented with advanced-stage disease (stage III and IV). Mucinous, signet, papillary, and other poor-risk histologic features were seen in 33 patients (55%). The treatment intention was radical for 50 patients (83.3%). The median follow-up period was 7.3 months. Eighteen patients had documented disease progression. Distant metastasis was the most common type of failure, seen in 14 of 18 patients (77%). The median progression-free survival (PFS) was 1.4 years. The 1- and 3-year PFS rates were 66.5% and 42.0%, respectively. On univariate analysis, the Karnofsky performance status and histologic type were significant prognostic factors for PFS.
A greater proportion of poor histologic subtypes was found among young patients with rectal cancer. The high incidence of poor histologic subtypes confers a poor prognosis in these patients.
直肠癌是全球第四大常见癌症。诊断的高峰年龄在七十岁左右。35岁以下的直肠癌患者非常特殊，因为与老年患者的直肠癌相比，他们具有不良的组织学特征且分期更晚。
我们回顾性评估了2007年至2013年在全印度研究所我们科室接受治疗的年轻直肠癌患者（年龄<35岁）的病历。
在研究期间，我们科室共登记了60例年轻直肠癌患者。3例患者有癌症家族史。就诊时的中位年龄为27.5岁（范围15 - 34岁）。男女比例为1.5:1。60例患者中，52例（86.6%）表现为晚期疾病（III期和IV期）。33例患者（55%）出现黏液性、印戒样、乳头状和其他预后不良的组织学特征。50例患者（83.3%）的治疗意向为根治性。中位随访期为7.3个月。18例患者记录有疾病进展。远处转移是最常见的失败类型，18例患者中有14例（77%）出现。中位无进展生存期（PFS）为1.4年。1年和3年的PFS率分别为66.5%和42.0%。单因素分析显示，卡诺夫斯基功能状态和组织学类型是PFS的重要预后因素。
年轻直肠癌患者中不良组织学亚型的比例更高。不良组织学亚型的高发生率使这些患者预后不良。
