McClelland Paul Hsin-Ti, Liu Tianming, Ozuner Gokhan
Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY.
Department of Surgery, Baylor College of Medicine, Houston, TX.
Clin Colorectal Cancer. 2022 Jun;21(2):e135-e144. doi: 10.1016/j.clcc.2021.11.003. Epub 2021 Nov 27.
Incidence of early-onset colorectal cancer (EO-CRC) is increasing in younger demographics. This study analyzes disease-specific survival in individuals under 50 years of age.
Patients with colorectal malignancy were identified in the Surveillance Epidemiology and End Results (SEER) database from 2004 to 2015. Cases were categorized into typically screened (age 50-79 years) and non-typically screened (age 20-49 years) cohorts, as well as by decade. Kaplan-Meier curves and Cox proportional hazard models were used to study survival.
A total of 240,772 patients with colorectal cancer were analyzed. Average annual percent change in incidence was -0.24% among typically screened patients and +1.12% among patients with EO-CRC. Patients with EO-CRC more frequently presented with distal tumors (70.6% vs. 57.6%, P < .001) and advanced tumor stage (61.3% vs. 48.6%, P < .001). Patients aged 50 and over had comparable 5 year disease-specific survival to younger patients (68.2% vs. 66.4%, P = .31); however, patients in the 3rd, 4th, and 8th decade of life had particularly low survival rates (59.0% vs. 65.8% vs. 65.8%, logrank P < .001). Patients aged 20-29 years had the most increased risk of cause-specific mortality on univariable Cox regression analysis [HR 1.43, 95% CI 1.31-1.56; P < .001], although this was not significant on multivariable analysis [HR 1.06, 95% CI 0.97-1.15; P = .201]. Male sex, older age, advanced stage, rectal and/or cecal primary, and earlier year of diagnosis were independently associated with increased mortality.
Patients with EO-CRC are diagnosed at a later stage and have lower disease-specific survival than those in typically screened cohorts. Additional studies on tumor biology and surveillance strategies are needed to improve outcomes in this population.
早发性结直肠癌（EO-CRC）在较年轻人群中的发病率正在上升。本研究分析了50岁以下个体的疾病特异性生存率。
在2004年至2015年的监测、流行病学和最终结果（SEER）数据库中识别出结直肠恶性肿瘤患者。病例被分为典型筛查队列（50-79岁）和非典型筛查队列（20-49岁），并按年代进行分类。采用Kaplan-Meier曲线和Cox比例风险模型来研究生存率。
共分析了240,772例结直肠癌患者。典型筛查患者的发病率年均变化百分比为-0.24%，而EO-CRC患者为+1.12%。EO-CRC患者更常出现远端肿瘤（70.6%对57.6%，P<.001）和晚期肿瘤分期（61.3%对48.6%，P<.001）。50岁及以上患者的5年疾病特异性生存率与较年轻患者相当（68.2%对66.4%，P=.31）；然而，处于生命第3、4和8个十年的患者生存率特别低（59.0%对65.8%对65.8%，logrank检验P<.001）。在单变量Cox回归分析中，20-29岁的患者因特定原因死亡的风险增加最多[风险比（HR）1.43，95%置信区间（CI）1.31-1.56；P<.001]，尽管在多变量分析中这并不显著[HR 1.06，95%CI 0.97-1.15；P=.201]。男性、年龄较大、晚期、直肠和/或盲肠原发以及较早的诊断年份与死亡率增加独立相关。
EO-CRC患者的诊断较晚，与典型筛查队列中的患者相比，其疾病特异性生存率较低。需要对肿瘤生物学和监测策略进行更多研究，以改善该人群的预后。
