Makmun Dadang, Simadibrata Marcellus, Abdullah Murdani, Syam Ari F, Shatri Hamzah, Fauzi Achmad, Renaldi Kaka, Maulahela Hasan, Utari Amanda P, Pribadi Rabbinu R, Muzellina Virly N, Nursyirwan Saskia A
Division of Gastroenterology, Pancreatobiliary & Digestive Endoscopy, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo National General Hospital, Jakarta 10430, Indonesia.
Clinical Epidemiology Unit, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo National General Hospital, Jakarta 10430, Indonesia.
World J Clin Cases. 2021 Nov 16;9(32):9804-9814. doi: 10.12998/wjcc.v9.i32.9804.
An increasing trend in colorectal cancer (CRC) occurring at younger ages has been observed worldwide, even though incidence is declining in the general population. Most currently available guidelines still recommend CRC screening for older populations, despite an alarming rise in early-onset CRC incidence. Risk stratification is necessary to further determine the population most at risk for early-onset CRC. However, epidemiological data on related clinical characteristics and potential risk factors, especially in developing countries, have not been widely reported.
To investigate the prevalence, demographics, clinicopathologic features, and associated factors of young-onset CRC patients in a tertiary hospital in Indonesia.
Patients undergoing colonoscopy examination between 2008 and 2019, yielding a diagnosis of CRC were identified from medical records. The subjects were classified into two groups according to their age at diagnosis, namely early-onset (18-49 years old) and late-onset (≥ 50-years-old). Demographic data, characteristics, and risk factors of both onset age groups were evaluated using the chi-square and Fisher's exact test.
Among 495 CRC patients confirmed by histopathology, 205 (41.4%) were classified as early-onset and 290 (58.6%) as late-onset. Most subjects in the early-onset CRC group were male (53.7%), with 89.8% displaying adenocarcinoma histopathology. A majority (78%) of the early-onset CRC patients had left-sided tumors, with the rectum (41%) and rectosigmoid (17.6%) being the most common sites. Abdominal pain was the most frequent symptom in the early-onset CRC patients (55.6%), which was significantly higher than that in the late-onset CRC patients (43.8%, < 0.05). Early-onset CRC cases were more likely to be underweight (34.6% 20.0%, < 0.001) compared to late-onset CRC cases. The proportion of subjects with suspected hereditary nonpolyposis colorectal cancer (HNPCC) was also higher in the early-onset CRC group than in the late-onset age group (9.3% 4.1%, < 0.05). However, no difference was observed in the parental or family histories of CRC cases.
Early-onset CRC patients were more likely to have abdominal pain, underweight status, and HNPCC suspicion than late-onset CRC patients.
尽管总体人群中结直肠癌（CRC）发病率呈下降趋势，但全球范围内年轻患者患CRC的趋势却在增加。尽管早发性CRC发病率惊人地上升，但目前大多数可用指南仍建议对老年人群进行CRC筛查。风险分层对于进一步确定早发性CRC风险最高的人群很有必要。然而，关于相关临床特征和潜在风险因素的流行病学数据，尤其是在发展中国家，尚未得到广泛报道。
调查印度尼西亚一家三级医院中早发性CRC患者的患病率、人口统计学特征、临床病理特征及相关因素。
从2008年至2019年接受结肠镜检查并确诊为CRC的患者病历中进行筛选。根据诊断时的年龄将受试者分为两组，即早发性（18 - 49岁）和晚发性（≥50岁）。使用卡方检验和Fisher精确检验评估两个发病年龄组的人口统计学数据、特征和危险因素。
在495例经组织病理学确诊的CRC患者中，205例（41.4%）被归类为早发性，290例（58.6%）为晚发性。早发性CRC组中的大多数受试者为男性（53.7%），89.8%表现为腺癌组织病理学。大多数（78%）早发性CRC患者患有左侧肿瘤，其中直肠（41%）和直肠乙状结肠（17.6%）是最常见的部位。腹痛是早发性CRC患者最常见的症状（55.6%），显著高于晚发性CRC患者（43.8%，P<0.05）。与晚发性CRC病例相比，早发性CRC病例体重过轻的可能性更高（34.6%对20.0%，P<0.001）。早发性CRC组中疑似遗传性非息肉病性结直肠癌（HNPCC）的受试者比例也高于晚发性年龄组（9.3%对4.1%，P<0.05）。然而，CRC病例的父母或家族史未观察到差异。
与晚发性CRC患者相比，早发性CRC患者更易出现腹痛、体重过轻及疑似HNPCC的情况。
