Gastroenterology Unit, Department of Medicine, Ampang Hospital, Ampang, Selangor, Malaysia.
Clinical Research Center, Sultanah Bahiyah Hospital, Alor Setar, Kedah, Malaysia.
Asian Pac J Cancer Prev. 2020 Apr 1;21(4):1057-1061. doi: 10.31557/APJCP.2020.21.4.1057.
While the world witnesses an increasing trend of young-onset colorectal cancer (CRC), the information regarding the impact of age on CRC is limited in Malaysia. This study aimed to compare the incidence, clinic-demographic profiles and survival rates of CRC between patients above and under 50 years of age in northern Malaysia.
This was a registry-based, cross-sectional study. All the CRC cases reported by 18 hospitals to the National Cancer Patient Registry - Colorectal Cancer (NCPR-CC) between January 2007 and December 2017 were included in the analysis. The patients were categorized by age into the above-50 and under-50 groups. The changes in the age-standardized incidence and mortality rates of both the age groups were determined using the time-series analysis, and the impact of age on the mortality risk was assessed using the Cox regression analysis.
Of the 6,172 CRC patients enrolled in the NCPR-CC, 893 (14.5%) were in the under-50 group. As compared with their older counterparts, the patients in the under-50 group were more likely to be female, be of Malay ethnicity, be non-smokers, have a family history of CRC, and present late for treatment. The age-standardized incidence and mortality rates of CRC in the under-50 group remained stable over the years, while a decreasing trend was clearly seen in the mortality rates of CRC in the above-50 group (p=0.003). Nevertheless, the two age groups also did not differ in the mortality risk (adjusted hazards ratio: 1.10; 95% CI: 0.90, 1.36).
Young-onset CRC constituted a considerable proportion of CRC cases in Malaysia. However, in contrast with the findings of most studies, it demonstrated neither an uptrend in age-standardized incidence rates nor a higher mortality risk. Our findings suggest the need to upscale and lower the recommended age for CRC screening in Malaysia.
尽管世界范围内青年结直肠癌（CRC）的发病率呈上升趋势，但马来西亚关于年龄对 CRC 影响的信息有限。本研究旨在比较马来西亚北部年龄在 50 岁以上和以下的 CRC 患者的发病率、临床-人口统计学特征和生存率。
这是一项基于登记的横断面研究。将 2007 年 1 月至 2017 年 12 月期间，18 家医院向国家癌症患者登记处-结直肠癌（NCPR-CC）报告的所有 CRC 病例纳入分析。患者根据年龄分为 50 岁以上和 50 岁以下两组。使用时间序列分析确定两组年龄标准化发病率和死亡率的变化，使用 Cox 回归分析评估年龄对死亡率风险的影响。
在 NCPR-CC 登记的 6172 例 CRC 患者中，有 893 例（14.5%）年龄在 50 岁以下。与年龄较大的患者相比，50 岁以下组的患者更可能为女性、马来族裔、不吸烟、有 CRC 家族史，并延迟治疗。50 岁以下组的 CRC 年龄标准化发病率和死亡率多年来保持稳定，而 50 岁以上组的 CRC 死亡率则呈明显下降趋势（p=0.003）。然而，这两个年龄组的死亡率风险也没有差异（调整后的危险比：1.10；95%CI：0.90，1.36）。
青年结直肠癌在马来西亚构成了相当比例的 CRC 病例。然而，与大多数研究的发现相反，它既没有表现出年龄标准化发病率的上升趋势，也没有更高的死亡率风险。我们的研究结果表明，需要在马来西亚扩大和降低 CRC 筛查的推荐年龄。
