Royal Free Hospital, London, UK.
Department of General Surgery, West Suffolk Hospital, Bury Saint Edmunds, UK.
J Invest Surg. 2020 Jul;33(6):514-519. doi: 10.1080/08941939.2018.1545060. Epub 2019 Jan 15.
Colorectal cancer (CRC) is the second commonest malignancy related death in Western Europe with incidence increasing in young adults. 31% of UK patients with CRC present as emergencies. We compare the incidence, characteristics, management and outcomes in two cohorts presenting as CRC emergencies; under-50 and over-50 years old. Retrospective analysis was performed on 322 patients with emergency presentations of CRC over a 9-year period (January 2005-December 2013, West Suffolk Hospital, UK). Data were analyzed for demographics, symptoms, investigations, stage, grade, genetics, tumor location, management, and mortality. 300 patients over 50 years old presented with CRC emergencies; 153 women (51%):147 men (49%); median age 77 years (interquartile range: 67-84). 22 patients under 50-years-old; 12 women (55%):10 men (45%); median age 43 years ([Interquartile Range (IQR)]: 35-46 years). Bowel obstruction was less common in under-50s (18.2% vs. 40.7%; = 0.04). No over-50s had a positive family history for CRC; 7 under-50s did. A higher proportion of under-50s presented with Dukes A carcinomas (14.3% vs. 0.4%; = 0.002), but no difference in other Dukes stages. Surgery was performed in a higher proportion of under-50s (95.5% vs. 77.0%; = 0.04) and a higher proportion had same day surgery (71.4% vs. 28.1%; = 0.01). Overall mortality was lower in under-50s (36.4% vs. 64.0%; = 0.02). No significant differences occurred in in-hospital mortality (4.7% vs. 8.0%; = 0.55), overall one-year survival (31.8% vs. 41.7%; = 0.36), or median survival to death or study conclusion (27.1 vs. 19.6 months; = 0.13). Emergency CRC had comparable outcomes between young and old cohorts, during the study time period. Younger patients were more likely to undergo operative interventions but overall survival was comparable.Our study was limited by the reporting biases intrinsic to retrospective analyses and by a small under-50 sample size. Further large-scale studies are warranted to support observations.
结直肠癌（CRC）是西欧第二大与死亡相关的常见恶性肿瘤，其在年轻人中的发病率正在上升。31%的英国 CRC 患者以急症就诊。我们比较了两个年龄组（50 岁以下和 50 岁以上）以 CRC 急症就诊的发生率、特征、管理和结局。对 9 年来（2005 年 1 月至 2013 年 12 月，英国西萨福克医院）因 CRC 急症就诊的 322 例患者进行了回顾性分析。对患者的人口统计学、症状、检查、分期、分级、遗传学、肿瘤部位、管理和死亡率进行了分析。300 名年龄超过 50 岁的患者出现 CRC 急症；153 名女性（51%）：147 名男性（49%）；中位年龄为 77 岁（四分位间距[IQR]：67-84）。22 名年龄在 50 岁以下的患者；12 名女性（55%）：10 名男性（45%）；中位年龄为 43 岁（IQR：35-46 岁）。50 岁以下患者的肠梗阻发生率较低（18.2%对 40.7%；=0.04）。50 岁以上患者无 CRC 阳性家族史；7 名 50 岁以下患者有。50 岁以下患者中 Dukes A 癌的比例较高（14.3%对 0.4%；=0.002），但其他 Dukes 分期无差异。50 岁以下患者手术比例较高（95.5%对 77.0%；=0.04），且当日手术比例较高（71.4%对 28.1%；=0.01）。50 岁以下患者的总死亡率较低（36.4%对 64.0%；=0.02）。院内死亡率无显著差异（4.7%对 8.0%；=0.55），总一年生存率（31.8%对 41.7%；=0.36），或中位生存期至死亡或研究结论（27.1 对 19.6 个月；=0.13）。在研究期间，年轻和年老队列的紧急 CRC 结局相似。年轻患者更有可能接受手术干预，但总体生存率相似。本研究受到回顾性分析固有的报告偏倚和小样本量的限制。需要进一步的大规模研究来支持这些观察结果。
