Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland.
School of Medicine, University College Dublin, Dublin, Ireland.
Br J Surg. 2020 Apr;107(5):606-612. doi: 10.1002/bjs.11526. Epub 2020 Mar 9.
The incidence of rectal cancer among adults aged less than 50 years is rising. Survival data are limited and conflicting, and the oncological benefit of standard neoadjuvant and adjuvant therapies is unclear.
Disease-specific outcomes of patients diagnosed with rectal cancer undergoing surgical resection with curative intent between 2006 and 2016 were analysed.
A total of 797 patients with rectal cancer were identified, of whom 685 had surgery with curative intent. Seventy patients were younger than 50 years and 615 were aged 50 years or more. Clinical stage did not differ between the two age groups. Patients aged less than 50 years were more likely to have microsatellite instability (9 versus 1·6 per cent; P = 0·003) and Lynch syndrome (7 versus 0 per cent; P < 0·001). Younger patients were also more likely to receive neoadjuvant chemoradiotherapy (67 versus 53·3 per cent; P = 0·003) and adjuvant chemotherapy (41 versus 24·2 per cent; P = 0·006). Five-year overall survival was better in those under 50 years old (80 versus 72 per cent; P = 0·013). The 5-year disease-free survival rate was 81 per cent in both age groups (P = 0·711). There were no significant differences in the development of locoregional recurrence or distant metastases.
Despite accessing more treatment, young patients have disease-specific outcomes comparable to those of their older counterparts.
50 岁以下成年人直肠癌的发病率正在上升。生存数据有限且相互矛盾，标准新辅助和辅助治疗的肿瘤学获益尚不清楚。
分析了 2006 年至 2016 年间接受根治性手术治疗的直肠癌患者的特定疾病结局。
共确定了 797 例直肠癌患者，其中 685 例接受了根治性手术。70 例患者年龄小于 50 岁，615 例患者年龄为 50 岁或以上。两个年龄组的临床分期没有差异。年龄小于 50 岁的患者更有可能出现微卫星不稳定性（9%比 1.6%；P=0.003）和林奇综合征（7%比 0%；P<0.001）。年轻患者也更有可能接受新辅助放化疗（67%比 53.3%；P=0.003）和辅助化疗（41%比 24.2%；P=0.006）。5 年总生存率在 50 岁以下患者中更好（80%比 72%；P=0.013）。两个年龄组的 5 年无病生存率均为 81%（P=0.711）。局部区域复发或远处转移的发展没有显著差异。
尽管接受了更多的治疗，但年轻患者的特定疾病结局与年龄较大的患者相当。
