Chou Chia-Lin, Tseng Chien-Jen, Shiue Yow-Ling
Division of General Surgery, Department of Surgery, Chi-Mei Medical Center, Tainan.
Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang-Ming University, Taipei.
Jpn J Clin Oncol. 2017 Nov 1;47(11):1010-1018. doi: 10.1093/jjco/hyx110.
The impact of age as a prognostic factor for patients with colorectal cancer (CRC) remains controversial, possibly due to heterogeneity between studies in terms of patient numbers, percentage of patients undergoing curative resection, percentage of patients receiving neoadjuvant therapy, or failure to adjust for potential confounding factors. This study used colorectal cancer survival data from the Taiwan Cancer Registry database in order to comprehensively analyze age as a prognostic factor.
Survival data were analyzed for 62 060 CRC patients diagnosed with adenocarcinoma, mucinous adenocarcinoma, or signet-ring cell carcinoma of the colon and rectum between 1998 and 2005. The rates of all-cause mortality and CRC-related mortality were determined using Kaplan-Meier analysis, and the log-rank test was used to compare differences in survival between different age groups. The crude and adjusted hazard ratios for all-cause and CRC-related mortalities were calculated according to the estimates from the univariable and multivariable Cox proportional hazard models.
Patients in the ≤40 and the 41-50 age groups had a higher proportion of mucinous adenocarcinoma (P < 0.001) and signet-ring cell carcinoma (P < 0.001) compared to the older age groups. After adjusting for gender, histology, and tumor site, patients in the ≤40 age group had a poorer overall survival (OS) and cancer-specific survival compared to patients in the 41-50 and 51-60, and 61-70 age groups (P < 0.001), but a better OS and cancer-specific survival compared to patients in the 71-80 and >80 age groups (P < 0.001).
Our study indicated that age is an important consideration while determining the clinical management of CRC patients.
年龄作为结直肠癌（CRC）患者的一个预后因素，其影响仍存在争议，这可能是由于不同研究在患者数量、接受根治性切除的患者百分比、接受新辅助治疗的患者百分比方面存在异质性，或者未能对潜在的混杂因素进行校正。本研究使用台湾癌症登记数据库中的结直肠癌生存数据，以便全面分析年龄作为一个预后因素。
对1998年至2005年间诊断为结肠和直肠腺癌、黏液腺癌或印戒细胞癌的62060例CRC患者的生存数据进行分析。使用Kaplan-Meier分析确定全因死亡率和CRC相关死亡率，并使用对数秩检验比较不同年龄组之间的生存差异。根据单变量和多变量Cox比例风险模型的估计值，计算全因和CRC相关死亡率的粗风险比和校正风险比。
与年龄较大的组相比，年龄≤40岁和41-50岁组的黏液腺癌（P<0.001）和印戒细胞癌（P<0.001）比例更高。在调整性别、组织学和肿瘤部位后，年龄≤40岁组的患者与41-50岁、51-60岁和61-70岁组的患者相比，总生存期（OS）和癌症特异性生存期较差（P<0.001），但与71-80岁和>80岁组的患者相比，OS和癌症特异性生存期更好（P<0.001）。
我们的研究表明，在确定CRC患者的临床管理时，年龄是一个重要的考虑因素。
