Department of Surgery, Center for Advanced Digestive Care, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY; Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY.
Institute for Computational Biomedicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY; Department of Medicine, Division of Hematology and Medical Oncology, Center for Advanced Digestive Care, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY.
Clin Colorectal Cancer. 2017 Dec;16(4):293-299.e6. doi: 10.1016/j.clcc.2017.06.002. Epub 2017 Jun 23.
Early-onset colorectal cancer (E-CRC) is increasing in incidence, unlike traditional CRC (T-CRC). We sought to characterize differences between E-CRC and T-CRC.
Data sources included the Surveillance, Epidemiology, and End Results database, the Behavioral Risk Factor Surveillance Survey, and The Cancer Genome Atlas (TCGA). We compared demographics, tumor characteristics, and incidence of CRC in subjects aged 20 to 49 years (E-CRC) with those aged ≥ 50 years (T-CRC). We correlated the incidence of E-CRC and T-CRC to CRC risk factors and age-dependent genomic characteristics of CRC using TCGA.
A total of 369,796 CRCs were identified (2000-2011). E-CRC incidence has risen 1.4% per year, whereas T-CRC has declined 3.1% per year (P < .05). The incidence of E-CRC increases in a step-wise fashion from the ascending colon to rectum (P < 2.2e-16). E-CRC is more prevalent in male (53.7% vs. 46.4%; P < .001), Black (14.6% vs. 11.0%; P < .001), and Hispanic (14.7% vs. 8.3%; P < .001) patients. E-CRC presents with aggressive histology, including high-grade (1.5% vs. 1.3%; P < .001), signet ring cell (1.9% vs. 0.9%; P < .001), and mucinous carcinomas (8.9% vs. 8.1%; P < .001), and more often with distant disease (24.4% vs. 18.8%; P < .001). The geographic distribution of E-CRC mirrors United States counties with higher Black population densities. Unlike T-CRC, E-CRC prevalence is not correlated with known CRC risk factors. E-CRC is associated with a lower rate of mutations than traditional CRC. Limitations of this study include E-CRC sample size for the TCGA analysis, as well as lack of comorbidity information and family history.
E-CRC tumors are clinically, pathologically, and molecularly distinct from T-CRC. Further evaluation of genetic and molecular differences is necessary to understand the pathophysiology of E-CRC and to help target treatment/surveillance strategies.
与传统结直肠癌（T-CRC）不同，早发性结直肠癌（E-CRC）的发病率正在增加。我们试图描述 E-CRC 和 T-CRC 之间的差异。
数据来源包括监测、流行病学和最终结果数据库、行为风险因素监测调查和癌症基因组图谱（TCGA）。我们比较了年龄在 20 至 49 岁（E-CRC）的受试者与年龄≥50 岁（T-CRC）的受试者的人口统计学特征、肿瘤特征和 CRC 发病率。我们使用 TCGA 分析 CRC 风险因素和与年龄相关的 CRC 基因组特征与 E-CRC 和 T-CRC 的发病率的相关性。
共确定了 369796 例 CRC（2000-2011 年）。E-CRC 的发病率每年增长 1.4%，而 T-CRC 的发病率每年下降 3.1%（P<0.05）。E-CRC 的发病率从升结肠到直肠呈阶梯式上升（P<2.2e-16）。E-CRC 在男性（53.7%比 46.4%；P<0.001）、黑人（14.6%比 11.0%；P<0.001）和西班牙裔（14.7%比 8.3%；P<0.001）患者中更为常见。E-CRC 具有侵袭性组织学特征，包括高级别（1.5%比 1.3%；P<0.001）、印戒细胞（1.9%比 0.9%；P<0.001）和黏液腺癌（8.9%比 8.1%；P<0.001），并且更常发生远处疾病（24.4%比 18.8%；P<0.001）。E-CRC 的地理分布反映了美国黑人人口密度较高的县。与 T-CRC 不同，E-CRC 的患病率与已知的 CRC 风险因素无关。E-CRC 的突变率低于传统 CRC。本研究的局限性包括 TCGA 分析中 E-CRC 样本量较小，以及缺乏合并症信息和家族史。
E-CRC 肿瘤在临床、病理和分子水平上与 T-CRC 不同。需要进一步评估遗传和分子差异，以了解 E-CRC 的病理生理学，并帮助确定治疗/监测策略。
