Reddy Shravani, Mouchli Awf, Bierle Lindsey, Gerrard Miranda, Walsh Chirstopher, Mir Adil, Lebel David P, Mason Christopher, Grider Douglas, Rubio Marrieth
Internal Medicine, Carilion Clinic, Roanoke, USA.
Gastroenterology, Cleveland Clinic, Cleveland, USA.
Cureus. 2021 Jul 2;13(7):e16117. doi: 10.7759/cureus.16117. eCollection 2021 Jul.
Background The presenting symptoms and co-morbidities contributing to mortality in young patients (age < 50 years old) with colorectal cancer (CRC) are poorly understood. We reviewed these features in our patient population with non-hereditary early-onset CRC (EO-CRC). Study aim This study aimed to assess characteristics of patients with a diagnosis of non-hereditary EO-CRC, including presenting symptoms and metabolic disorders contributing to mortality in underserved areas of southwest Virginia. Methods In this retrospective observational study, we selected patients aged 18-50 years with a diagnosis of non-hereditary EO-CRC from 2008 to 2016 at Carilion Roanoke Memorial Hospital. The electronic medical record was queried to identify demographic data, medical history, histopathology results, lab values, and mortality. The cumulative risks of symptoms and co-morbid metabolic disorders was estimated using Kaplan-Meier curves. Results We identified 139 patients with non-hereditary EO-CRC (mean age 41.6 ± 6.9 years). Almost half of these patients were obese (BMI > 30), 30.9% had a diagnosis of hypertension, 29% had hyperlipidemia (HLD), and 17.35% had diabetes mellitus type 2 (DM2). Diagnosis was delayed by 4.5 months from initial presentation, and 17% had advanced disease (stage III/IV). Also, 68.5% of patients were symptomatic with one to three symptoms, most commonly with rectal bleeding (45.3%). The chronicity of HLD (≥5 years) was associated with reduced survival in our patients with EO-CRC. The survival of females with multiple metabolic disorders was reduced compared to females with a single metabolic disorder. Conclusions Multiple symptoms, chronic HLD, and female gender with multiple metabolic disorders were factors associated with poor outcomes in non-hereditary EO-CRC patients.
目前对于年轻（年龄<50岁）结直肠癌（CRC）患者导致死亡的症状及合并症了解甚少。我们对非遗传性早发性结直肠癌（EO-CRC）患者群体的这些特征进行了回顾。
本研究旨在评估非遗传性EO-CRC患者的特征，包括弗吉尼亚西南部服务欠缺地区导致死亡的症状及代谢紊乱情况。
在这项回顾性观察研究中，我们选取了2008年至2016年在卡里里昂罗阿诺克纪念医院诊断为非遗传性EO-CRC的18至50岁患者。通过查询电子病历确定人口统计学数据、病史、组织病理学结果、实验室检查值及死亡率。使用Kaplan-Meier曲线估计症状及合并代谢紊乱的累积风险。
我们确定了139例非遗传性EO-CRC患者（平均年龄41.6±6.9岁）。这些患者中近一半肥胖（BMI>30），30.9%诊断为高血压，29%患有高脂血症（HLD），17.35%患有2型糖尿病（DM2）。从首次出现症状到确诊延迟了4.5个月，17%患有晚期疾病（III/IV期）。此外，68.5%的患者有一至三种症状，最常见的是直肠出血（45.3%）。HLD的慢性病程（≥5年）与我们的EO-CRC患者生存率降低相关。患有多种代谢紊乱的女性患者生存率低于患有单一代谢紊乱的女性。
多种症状、慢性HLD以及患有多种代谢紊乱的女性是与非遗传性EO-CRC患者不良预后相关的因素。
