Kim Tae Jun, Kim Eun Ran, Hong Sung Noh, Chang Dong Kyung, Kim Young-Ho
From the Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Medicine (Baltimore). 2016 May;95(19):e3641. doi: 10.1097/MD.0000000000003641.
The prognosis of early-onset sporadic colorectal cancer (CRC) patients remains controversial. The objective of this study was to assess the long-term outcome and prognostic factors of sporadic CRC in young patients.From 2006 to 2011, 8207 patients underwent curative or palliative surgery for CRCs in our institution. A total of 693 patients who were ≤45 years old with sporadic CRC were enrolled as the young group. A total of 1823 patients aged between 56 and 65 years were identified as middle-aged control group for this study. Survival outcome and prognostic factors were compared between the two groups.Young patients had higher recurrence rate than older patients in stages I and II (8.8% vs 2.7%, P <0.001). There was no significant difference of recurrence rate in stage III and IV cancers (27.5% vs 27.9%, P = 0.325). Metachronous cancers were developed more frequently in young patients (1.4% vs 0.6%, P = 0.038). Advanced stage CRC was diagnosed significantly more common in the young group (55.6% vs 47.9%, P = 0.001). High microsatellite instability (MSI) tumors are less likely to have advanced stage cancers (odds ratio (OR) 0.23, 95% confidence interval (CI) = 0.07-0.70) or cancer recurrence (OR 0.11, 95% CI = 0.01-0.85) in young patients. Cancer-specific survival was worse in young patients than that in older patients (81.2% vs 87.8%, P <0.001). However, there was no significant difference in cancer-specific survival for each stage between the two groups. Independent prognostic factors for survival in young patients were undifferentiated cancer (hazard ratio (HR) 2.30, 95% CI = 1.23-4.31) and 3 months or longer duration of symptom (HR 2.57, 95% CI = 1.34-4.94). Young women had better survival compared with young men (HR 0.55, 95% CI = 0.33-0.90).Prognosis of sporadic CRC in young patients is poorer than older patients, because of poorer histologic differentiation and delay in diagnosis. Early detection of CRC confers survival benefit to young patients. Because of higher recurrence rate and metachronous cancer risk, post-operative surveillance is also important in young patients.
早发性散发性结直肠癌（CRC）患者的预后仍存在争议。本研究的目的是评估年轻患者散发性CRC的长期结局和预后因素。2006年至2011年，8207例患者在我院接受了CRC的根治性或姑息性手术。共有693例年龄≤45岁的散发性CRC患者被纳入年轻组。共有1823例年龄在56至65岁之间的患者被确定为本研究的中年对照组。比较两组的生存结局和预后因素。年轻患者在I期和II期的复发率高于老年患者（8.8%对2.7%，P<0.001）。III期和IV期癌症的复发率无显著差异（27.5%对27.9%，P=0.325）。异时性癌在年轻患者中更常见（1.4%对0.6%，P=0.038）。年轻组中晚期CRC的诊断明显更常见（55.6%对47.9%，P=0.001）。高微卫星不稳定性（MSI）肿瘤在年轻患者中发生晚期癌症（优势比（OR）0.23，95%置信区间（CI）=0.07-0.70）或癌症复发（OR 0.11，95%CI=0.01-0.85）的可能性较小。年轻患者的癌症特异性生存率低于老年患者（81.2%对87.8%，P<0.001）。然而，两组各阶段的癌症特异性生存率无显著差异。年轻患者生存的独立预后因素是未分化癌（风险比（HR）2.30，95%CI=1.23-4.31）和症状持续3个月或更长时间（HR 2.57，95%CI=1.34-4.94）。年轻女性的生存率优于年轻男性（HR 0.55，95%CI=0.33-0.90）。年轻患者散发性CRC的预后比老年患者差，原因是组织学分化较差和诊断延迟。早期发现CRC可使年轻患者获得生存益处。由于复发率较高和异时性癌风险，术后监测对年轻患者也很重要。
