Division of Colorectal Surgery, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute (HNBI), Mumbai, Maharashtra, India, 400012.
Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Dr Ernest Borges Marg, Parel, Mumbai, 400012, Maharashtra, India.
Langenbecks Arch Surg. 2022 Aug;407(5):2027-2034. doi: 10.1007/s00423-022-02500-0. Epub 2022 Apr 5.
Early-onset colon cancers are increasing and the independent influence of age on prognosis and therapeutic efficacy of adjuvant therapy is unclear. The primary aim of the present study was to determine if young age was an independent prognostic factor for survival. Secondarily, age would be used in the context of known factors that predict benefit with adjuvant chemotherapy in stages II and III.
Retrospective, single centre study of operated, non-metastatic colon cancer (> 15 cm from anal verge) without pre-operative therapy. Early onset cancers were defined as age ≤ 45 years. Primary endpoint was disease-free survival (DFS).
Six-hundred thirty-three patients were included with 206 (32.5%) early-onset cancers. With a median follow-up of 48 months, 5-year DFS was 79.5% and 76.2% for early and late-onset cancers, respectively (p - 0.585). In multivariate analysis, only tumour sidedness, family history, T4 stage, node positivity and microsatellite instability status influenced DFS and not the age of onset (HR - 0.969; 95% - 0.63-1.49). These results were consistent with different models and with stage-wise distribution.
Early-onset colon cancers treated with curative intent had survivals similar to older cohorts. Age was not an independent prognostic factor for recurrences. Age did not influence disease-free survival when stage-wise predictive variables for therapeutic benefit with adjuvant chemotherapy were considered.
早发性结肠癌的发病率正在增加，年龄对辅助治疗的预后和疗效的独立影响尚不清楚。本研究的主要目的是确定年龄是否是生存的独立预后因素。其次，将年龄用于预测 II 期和 III 期辅助化疗获益的已知因素。
回顾性分析接受手术治疗、无术前治疗的非转移性结肠癌（距肛门 15cm 以上）的单中心研究。早发性癌症定义为年龄≤45 岁。主要终点是无病生存（DFS）。
共纳入 633 例患者，其中 206 例（32.5%）为早发性癌症。中位随访 48 个月，早发性和晚发性癌症的 5 年 DFS 分别为 79.5%和 76.2%（p=0.585）。多因素分析显示，仅肿瘤侧别、家族史、T4 期、淋巴结阳性和微卫星不稳定性状态影响 DFS，而发病年龄无影响（HR=0.969；95%CI：0.63-1.49）。这些结果与不同模型和分期分布一致。
以治愈为目的治疗的早发性结肠癌的生存率与较年长的患者相似。年龄不是复发的独立预后因素。当考虑辅助化疗治疗获益的预测因素时，年龄不影响无病生存率。
