Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China.
Department of Radiation Oncology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China.
J Cancer Res Clin Oncol. 2021 Apr;147(4):1145-1155. doi: 10.1007/s00432-020-03397-2. Epub 2020 Sep 23.
Colorectal cancer (CRC) rarely occurs in children and adolescents. This study aimed to perform a retrospective analysis and disclose more detailed information about CRC in patients under 20 years old.
Medical records of CRCs in patients under 20 years old referred to three tertiary hospitals in China from September 2000 to July 2019 were retrospectively reviewed. Clinicopathological characteristics, treatment processes and laboratory findings were summarized and treatment outcomes and prognostic factors were analyzed.
A total of 33,394 CRC medical records were analyzed, and we identified seventy (0.21%) CRCs in patients under 20. The most common primary tumor location was the left hemicolon (35.7%). The prominent pathological types were mucinous adenocarcinoma (22.9%) and signet ring cell carcinoma (22.9%). Nearly half (47.1%) of the patients presented with distant metastasis at diagnosis. The fractions of patients with deficient mismatch repair (dMMR) protein expression and microsatellite instability-high (MSI-H) were 23.8% (5/21) and 71.4% (5/7), respectively. Forty-four patients underwent radical surgery. Fifty-five patients received chemotherapy and six patients received radiotherapy. One dMMR/MSI-H rectal cancer patient received immunotherapy and achieved a clinically complete response. The median overall survival (OS) time was 80 months. The 3-year and 5-year OS rates were 61.8% and 57.2%, respectively. An absence of distant metastasis was a favorable factor for OS. For stage II/III CRCs, classic adenocarcinoma and radical surgery were favorable factors for OS. For stage IV CRCs, primary location at the colon was a favorable factor for OS.
Child and adolescent CRC patients are likely to have distant metastasis, undifferentiated, left hemicolon location, and a dMMR/MSI-H phenotype at diagnosis. Additional efforts are needed to improve their survival outcomes.
结直肠癌（CRC）在儿童和青少年中很少见。本研究旨在进行回顾性分析，以提供更多关于 20 岁以下 CRC 患者的详细信息。
回顾性分析 2000 年 9 月至 2019 年 7 月期间中国 3 家三级医院的 20 岁以下 CRC 患者的病历。总结临床病理特征、治疗过程和实验室检查结果，并分析治疗结局和预后因素。
共分析了 33394 份 CRC 病历，发现 70 例（0.21%）20 岁以下 CRC 患者。最常见的原发肿瘤部位是左半结肠（35.7%）。突出的病理类型为黏液腺癌（22.9%）和印戒细胞癌（22.9%）。近一半（47.1%）患者在诊断时即有远处转移。缺乏错配修复缺陷（dMMR）蛋白表达和微卫星高度不稳定（MSI-H）的患者比例分别为 23.8%（5/21）和 71.4%（5/7）。44 例患者接受根治性手术，55 例接受化疗，6 例接受放疗。1 例 dMMR/MSI-H 直肠腺癌患者接受免疫治疗并达到临床完全缓解。中位总生存（OS）时间为 80 个月，3 年和 5 年 OS 率分别为 61.8%和 57.2%。无远处转移是 OS 的有利因素。对于 II/III 期 CRC，经典腺癌和根治性手术是 OS 的有利因素。对于 IV 期 CRC，肿瘤原发部位在结肠是 OS 的有利因素。
儿童和青少年 CRC 患者在诊断时可能存在远处转移、未分化、左半结肠位置和 dMMR/MSI-H 表型。需要进一步努力提高他们的生存结局。
