Gerald Bronfman Department of Oncology, McGill University Faculty of Medicine, Montreal, QC, Canada.
Department of Medical Oncology, Paoli-Calmettes Institute, Marseille, France.
Clin Colorectal Cancer. 2017 Dec;16(4):334-342. doi: 10.1016/j.clcc.2017.03.008. Epub 2017 Mar 21.
Compared with the general population, the incidence of young-onset (YO) colorectal cancer (CRC) is increasing. However, a significant knowledge gap exists in the clinical characteristics, treatment patterns, and outcomes for these patients.
Six international tertiary cancer centers conducted a retrospective study. Patients with YO CRC (aged 18-44 years) and LO CRC (aged > 44 years) diagnosed with histologically proven colorectal adenocarcinoma from June 2003 to June 2014 were enrolled. Patients were randomly chosen from each center's database, and the patient demographics and treatment information were collected. The data were then centralized, and the final analysis was performed at a single institution. Cox proportional hazards models were used to estimate the crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for progression-free survival and mortality, and YO was compared with LO. Site-specific HRs were pooled using a random-effects meta-analysis.
Overall, 498 patients, including 224 with YO (129 men; mean age, 37 ± 5.5 years) and 274 with LO (167 men; mean age, 64.8 ± 9.5 years) CRC, were included. At the diagnosis, 137 patients (61.2%) and 122 patients (44.5%) with YO and LO CRC had metastatic disease, respectively. For both cohorts, the 3 most common presenting symptoms were pain, hematochezia, and weight loss. Surgery was performed in 141 YO (63.0%) and 219 LO (79.9%) patients. The longitudinal noncurative treatment patterns were similar, but more biologic therapy was used for these YO patients. The pooled progression-free survival analysis results for first-line noncurative treatment favored LO (HR, 1.96; 95% CI, 1.04-3.68). The mortality analysis showed no significant differences between the 2 groups (YO: HR, 1.53; 95% CI, 0.91-2.58).
Despite similar treatment patterns and survival outcomes, YO disease might be clinically more aggressive.
与一般人群相比，青年发病（YO）结直肠癌（CRC）的发病率正在增加。然而，这些患者的临床特征、治疗模式和结局仍存在显著的知识空白。
六家国际三级癌症中心进行了一项回顾性研究。招募了 2003 年 6 月至 2014 年 6 月期间经组织学证实为结直肠腺癌的 YO CRC（年龄 18-44 岁）和 LO CRC（年龄>44 岁）患者。从每个中心的数据库中随机选择患者，收集患者的人口统计学和治疗信息。然后集中数据，在单一机构进行最终分析。使用 Cox 比例风险模型估计无进展生存期和死亡率的粗和调整危险比（HR），并将 YO 与 LO 进行比较。使用随机效应荟萃分析汇总部位特异性 HR。
共有 498 例患者，包括 224 例 YO（129 例男性；平均年龄 37 ± 5.5 岁）和 274 例 LO（167 例男性；平均年龄 64.8 ± 9.5 岁）CRC。在诊断时，分别有 137 例（61.2%）和 122 例（44.5%）YO 和 LO CRC 患者存在转移性疾病。对于两个队列，最常见的三个首发症状是疼痛、血便和体重减轻。在 141 例 YO（63.0%）和 219 例 LO（79.9%）患者中进行了手术。非治愈性治疗的纵向模式相似，但 YO 患者使用了更多的生物治疗。一线非治愈性治疗的汇总无进展生存分析结果有利于 LO（HR，1.96；95%CI，1.04-3.68）。死亡率分析显示两组之间无显著差异（YO：HR，1.53；95%CI，0.91-2.58）。
尽管治疗模式和生存结果相似，但 YO 疾病可能在临床上更具侵袭性。
