Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, MA.
Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Dipartimento di Oncologia e Emato-Oncologia, Università degli Studi di Milano (La Statale), Milan, Italy.
JCO Oncol Pract. 2021 Dec;17(12):e1846-e1855. doi: 10.1200/OP.20.01010. Epub 2021 May 27.
Colorectal cancer (CRC) incidence in patients younger than 50 years of age, commonly defined as early-onset (EO-CRC), is rising. EO-CRC often presents with distinct clinicopathologic features. However, data on prognosis are conflicting and outcomes with modern treatment approaches for metastatic disease are still limited.
We prospectively enrolled patients with metastatic CRC (mCRC) to a biobanking and clinical data collection protocol from 2014 to 2018. We grouped the cohort based on age at initial diagnosis: < 40 years, 40-49 years, and ≥ 50 years. We used regression models to examine associations among age at initial diagnosis, treatments, clinicopathologic features, and survival.
We identified 466 patients with mCRC (45 [10%] age < 40 years, 109 [23%] age 40-49 years, and 312 [67%] age ≥ 50 years). Patients < 40 years of age were more likely to have received multiple metastatic resections (odds ratio [OR], 3.533; = .0066) than their older counterparts. Patients with EO-CRC were more likely to receive triplet therapy than patients > 50 years of age (age < 40 years: OR, 6.738; = .0002; age 40-49 years: OR, 2.949; = .0166). Patients 40-49 years of age were more likely to have received anti-EGFR therapy (OR, 2.633; = .0016). Despite differences in care patterns, age did not predict overall survival.
Despite patients with EO-CRC receiving more intensive treatments, survival was similar to the older counterpart. However, EO-CRC had clinical and molecular features associated with worse prognoses. Improved biologic understanding is needed to optimize clinical management of EO-CRC. The cost-benefit ratio of exposing patients with EO-CRC to more intensive treatments has to be carefully evaluated.
50 岁以下患者的结直肠癌（CRC）发病率，通常被定义为早发性（EO-CRC），正在上升。EO-CRC 通常表现出明显的临床病理特征。然而，关于预后的数据存在争议，并且对于转移性疾病的现代治疗方法的结果仍然有限。
我们从 2014 年到 2018 年，前瞻性地招募了参加生物库和临床数据收集方案的转移性 CRC（mCRC）患者。我们根据初始诊断时的年龄将队列分组：<40 岁、40-49 岁和≥50 岁。我们使用回归模型来研究初始诊断年龄、治疗方法、临床病理特征和生存之间的关系。
我们确定了 466 名 mCRC 患者（45 名<40 岁，109 名 40-49 岁，312 名≥50 岁）。<40 岁的患者比年龄较大的患者更有可能接受多次转移性切除术（优势比[OR]，3.533；=.0066）。EO-CRC 患者比年龄较大的患者更有可能接受三联疗法（<40 岁：OR，6.738；=.0002；40-49 岁：OR，2.949；=.0166）。40-49 岁的患者更有可能接受抗 EGFR 治疗（OR，2.633；=.0016）。尽管治疗模式存在差异，但年龄并未预测总生存期。
尽管 EO-CRC 患者接受了更密集的治疗，但生存情况与年龄较大的患者相似。然而，EO-CRC 具有与预后较差相关的临床和分子特征。需要更好地了解生物学，以优化 EO-CRC 的临床管理。必须仔细评估将 EO-CRC 患者暴露于更密集治疗的成本效益比。
