Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
Eur J Surg Oncol. 2022 Apr;48(4):857-863. doi: 10.1016/j.ejso.2021.10.021. Epub 2021 Oct 28.
while interest on early-onset colorectal cancer (age ≤49) is on the rise, studies on early-onset rectal cancer (EORC) are limited. The aim of this study was to compare predictors for disease progression/recurrence between sporadic EORC and late-onset RC patients (LORC).
163 EORC and 830 LORC operated between January 1st 2010 and April 30th 2021 at a tertiary center were included. Demographics, tumor characteristics, microsatellite status, gene mutations (KRAS, BRAF, NRAS, PI3Kca) and oncologic outcomes were compared. A Cox proportional hazards regression analysis was performed to ascertain the effect of variables on recurrence/progression and death. Recurrence/Progression free survival (R/PFS) and cancer specific survival (CSS) were analyzed by the Kaplan-Meier estimator.
Mean age of EORC was 42.16, (46% aged 45-49). A majority of EORC patients had a family history for CRC (p = 0.01) and underwent total neoadjuvant treatment (p = 0.01). EORC patients showed a higher rate of low-grade tumor differentiation (p < 0.0001), stage III-IV (p = 0.001), microsatellite instability (p = 0.02), locoregional nodal (p = 0.001) and distant metastases (p < 0.0001). Accordingly, more EORC patients underwent adjuvant treatment (p < 0.0001). Mutations were mostly reported among LORC cases (p = 0.04), whereas EORC patients showed a worse R/PFS (p = 0.02), even at stage I (p = 0.04). CSS did not differ (p = 0.11) across groups. Multivariate analysis indicated age of onset (p = 0.04) was an independent predictor for progression/recurrence.
Age of onset was shown to be an independent unfavorable predictor. Delayed diagnosis could explain this effect in the more advanced stages, while the worse outcomes in stage I may suggest a more aggressive disease behavior.
虽然人们对早发性结直肠癌（年龄≤49 岁）的兴趣日益增加，但早发性直肠癌（EORC）的研究却很有限。本研究旨在比较散发性 EORC 和晚发性直肠肿瘤（LORC）患者疾病进展/复发的预测因素。
纳入 2010 年 1 月 1 日至 2021 年 4 月 30 日在一家三级中心接受治疗的 163 例 EORC 和 830 例 LORC 患者。比较了人口统计学、肿瘤特征、微卫星状态、基因突变（KRAS、BRAF、NRAS、PI3Kca）和肿瘤学结果。采用 Cox 比例风险回归分析确定变量对复发/进展和死亡的影响。采用 Kaplan-Meier 估计法分析无复发生存率（R/PFS）和癌症特异性生存率（CSS）。
EORC 的平均年龄为 42.16 岁（46%的患者年龄在 45-49 岁）。大多数 EORC 患者有结直肠癌家族史（p=0.01），并接受了全直肠新辅助治疗（p=0.01）。EORC 患者肿瘤分化程度较低（p<0.0001）、III-IV 期（p=0.001）、微卫星不稳定（p=0.02）、局部区域淋巴结（p=0.001）和远处转移（p<0.0001）的发生率较高。相应地，更多的 EORC 患者接受了辅助治疗（p<0.0001）。突变主要在 LORC 病例中报告（p=0.04），而 EORC 患者的 R/PFS 更差（p=0.02），即使在 I 期（p=0.04）也是如此。各组间 CSS 无差异（p=0.11）。多变量分析表明，发病年龄（p=0.04）是疾病进展/复发的独立预测因素。
发病年龄是独立的不利预测因素。较晚的诊断可能会解释晚期阶段的这种影响，而 I 期的预后较差可能提示疾病行为更具侵袭性。
