Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital and Academic Institute, Harrow, Middlesex, UK.
Department of Surgery and Cancer, Imperial College London, London, UK.
Colorectal Dis. 2020 Mar;22(3):289-297. doi: 10.1111/codi.14871. Epub 2019 Oct 30.
Colorectal cancer (CRC) is uncommon in patients under the age of 40 years and its association with poor histological features and survival is uncertain. This study aimed to evaluate age-related differences in clinicopathological features and prognosis in patients diagnosed with CRC.
A single-centre retrospective review of all patients diagnosed with CRC between 2004 and 2013 was performed. Patients were stratified into three age groups: (1) 18-40 years, (2) 41-60 years and (3)> 60 years. Clinicopathological characteristics and outcomes were compared between the three groups.
A total of 1328 patients were included, of whom 57.2% were men. There were 28 (2.1%) patients in group 1, 287 (21.6%) in group 2 and 1013 (76.3%) in group 3. Group 1 had the highest proportion of rectal tumours (57.1% in group 1, 50.2% in group 2 and 31.9% in group 3; P < 0.001). Tumour histology and disease stage were comparable between the groups. Group 1 had significantly worse disease-free survival (DFS) than the two older groups (44%, 78% and 77%, respectively; P = 0.022). Multivariate analysis demonstrated that age was not an independent prognostic factor whereas Stage III disease [hazard ratio (HR) 4.42; 95% CI 2.81-6.94; P < 0.001] and neoadjuvant chemotherapy (HR 1.65; 95% CI 1.06-2.58; P = 0.026) were associated with increased risk of recurrence.
Patients under the age of 40 are more likely to present with rectal cancer and have comparable histological features than the older groups. Despite higher rates of adjuvant and neoadjuvant treatment, the young group were found to have worse DFS.
结直肠癌（CRC）在 40 岁以下的患者中并不常见，其与不良组织学特征和生存的关系尚不确定。本研究旨在评估诊断为 CRC 的患者年龄相关的临床病理特征和预后差异。
对 2004 年至 2013 年间所有诊断为 CRC 的患者进行单中心回顾性研究。患者分为三组：（1）18-40 岁，（2）41-60 岁，（3）>60 岁。比较三组间的临床病理特征和结局。
共纳入 1328 例患者，其中 57.2%为男性。1 组 28 例（2.1%），2 组 287 例（21.6%），3 组 1013 例（76.3%）。1 组直肠肿瘤比例最高（1 组 57.1%，2 组 50.2%，3 组 31.9%；P<0.001）。各组肿瘤组织学和疾病分期相似。1 组无病生存率（DFS）明显低于两个年龄较大的组（44%、78%和 77%；P=0.022）。多因素分析表明，年龄不是独立的预后因素，而 III 期疾病[风险比（HR）4.42；95%置信区间（CI）2.81-6.94；P<0.001]和新辅助化疗（HR 1.65；95%CI 1.06-2.58；P=0.026）与复发风险增加相关。
40 岁以下的患者更有可能出现直肠癌，且其组织学特征与年龄较大的患者相似。尽管接受辅助和新辅助治疗的比例较高，但年轻组的 DFS 较差。
