Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan.
Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan.
BMC Cancer. 2018 Mar 27;18(1):334. doi: 10.1186/s12885-018-4241-9.
The incidence of colorectal cancer in adolescent and young adult patients is increasing. However, survival and clinical features of young patients, especially those with stage IV disease, relative to adult patients remain unclear.
This retrospective single-institution cohort study was conducted at a tertiary care cancer center. Subjects were 861 consecutive patients who were diagnosed with stage IV colorectal cancer at the age of 15 to 74 years and who were referred to the division of surgery or gastrointestinal oncology at the National Cancer Center Hospital from 1999 to 2013. Overall survival (OS) was investigated and clinicopathological variables were analyzed for prognostic significance.
Of these, 66 (8%) were adolescent and young adult patients and 795 (92%) were adult patients. Median survival time was 13.6 months in adolescent and young adult patients and 22.4 months in adult patients, and 5-year OS rates were 17.3% and 20.3%, respectively, indicating significant worse prognosis of adolescent and young adult patients (p = 0.042). However, age itself was not an independent factor associated with prognosis by multivariate analysis. When compared with adult patients, adolescent and young adult patients consisted of higher proportion of the patients who did not undergo resection of primary tumor, which was an independent factor associated with poor prognosis in multivariate analysis. In patients who did not undergo resection (n = 349), OS of adolescent and young adult patients were significantly worse (p = 0.033).
Prognoses were worse in adolescent and young adult patients with stage IV colorectal cancer compared to adult patients in Japan, due to a higher proportion of patients who did not undergo resection with more advanced and severe disease, but not due to age itself.
青少年和年轻成年患者的结直肠癌发病率正在增加。然而，与成年患者相比，年轻患者的生存和临床特征，尤其是那些患有 IV 期疾病的患者，尚不清楚。
这是一项在三级癌症中心进行的回顾性单机构队列研究。研究对象为 861 名连续患者，他们于 1999 年至 2013 年期间在国立癌症中心医院的外科或胃肠肿瘤学部门被诊断为 15 至 74 岁的 IV 期结直肠癌。研究调查了总生存期（OS），并分析了临床病理变量的预后意义。
其中，66 例（8%）为青少年和年轻成年患者，795 例（92%）为成年患者。青少年和年轻成年患者的中位生存时间为 13.6 个月，成年患者为 22.4 个月，5 年 OS 率分别为 17.3%和 20.3%，表明青少年和年轻成年患者的预后明显较差（p=0.042）。然而，年龄本身并不是多变量分析中与预后相关的独立因素。与成年患者相比，青少年和年轻成年患者中未行原发肿瘤切除术的患者比例较高，这是多变量分析中与预后不良相关的独立因素。在未行切除术的患者中（n=349），青少年和年轻成年患者的 OS 明显较差（p=0.033）。
与日本成年患者相比，IV 期结直肠癌的青少年和年轻成年患者预后较差，这是由于未行切除术的患者比例较高，疾病更晚期且更严重，但并非由于年龄本身。
