Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China; Hereditary Colorectal Cancer Center and Genetic Block Center of Familial Cancer, Changhai Hospital, Shanghai, China.
Department of Nephrology, Changhai Hospital, Naval Medical University, Shanghai, China.
Int J Surg. 2022 Aug;104:106780. doi: 10.1016/j.ijsu.2022.106780. Epub 2022 Jul 16.
In recent decades, the incidence of early-onset colorectal cancer (EOCRC) has reportedly increased in several developed countries, whereas that of late-onset colorectal cancer (LOCRC) has decreased continuously. The trends, clinicopathological features, surgical treatment patterns, and prognoses of EOCRC and LOCRC in China remain unclear.
This retrospective cohort study was performed in China using data from our pathology registry collected in 2000-2021. Pathologically confirmed cases of colorectal cancer (CRC) were analyzed. The average annual percentage change (AAPC) was estimated to quantify the secular trends. Clinicopathological features, surgical treatment patterns, and prognoses were compared between the two groups. Multivariate Cox regression analyses were performed for disease-free survival and overall survival.
A total of 34,067 cases of CRC were included, with 6,369 cases of EOCRC and 27,698 cases of LOCRC. Overall, the numbers of EOCRC (AAPC = 8.4%), LOCRC (AAPC = 11.6%), and CRC (AAPC = 11.0%) cases increased significantly from 2000 to 2021. Compared to the LOCRC group, the EOCRC group had fewer men, comorbidities, concomitant cancers, polyps, and KRAS mutations; more symptoms, rectal cancers, multiple primary CRCs, deficient mismatch repair tumors, poorly differentiated, mucinous adenocarcinoma or signet ring cell carcinoma, advanced TNM stage, vascular invasion, perineural invasion; less laparoscopic surgery and sphincter-preserving surgery; more extended radical resection, perioperative chemoradiotherapy and targeted therapy; and similar disease-free and overall survival rates.
The numbers of EOCRC and LOCRC cases have continuously increased over the last two decades. The EOCRC group has more aggressive features, advanced TNM stage, intensified surgical treatment and perioperative treatment than the LOCRC group, but similar disease-free and overall survival rates. More CRC screening programs are recommended for younger adults to combat the rapidly increasing trend of EOCRC.
近几十年来，一些发达国家的早发性结直肠癌（EOCRC）发病率有所上升，而晚发性结直肠癌（LOCRC）的发病率则持续下降。中国 EOCRC 和 LOCRC 的趋势、临床病理特征、手术治疗模式和预后尚不清楚。
本研究采用回顾性队列研究，利用 2000 年至 2021 年中国病理登记处的数据。对经病理证实的结直肠癌（CRC）病例进行分析。估计平均年变化百分比（AAPC）以量化时间趋势。比较两组的临床病理特征、手术治疗模式和预后。采用多变量 Cox 回归分析无病生存和总生存。
共纳入 34067 例 CRC 病例，其中 EOCRC 6369 例，LOCRC 27698 例。总体而言，2000 年至 2021 年，EOCRC（AAPC=8.4%）、LOCRC（AAPC=11.6%）和 CRC（AAPC=11.0%）的病例数均显著增加。与 LOCRC 组相比，EOCRC 组男性、合并症、合并癌、息肉、KRAS 突变较少；症状、直肠癌、多原发 CRC、错配修复缺陷型肿瘤、低分化、黏液腺癌或印戒细胞癌、更晚期的 TNM 分期、血管侵犯、神经周围侵犯较多；腹腔镜手术和保留括约肌手术较少；扩大根治性切除术、围手术期放化疗和靶向治疗较多；无病生存率和总生存率相似。
过去二十年，EOCRC 和 LOCRC 的病例数持续增加。EOCRC 组具有更具侵袭性的特征，TNM 分期更晚，手术治疗和围手术期治疗更强化，与 LOCRC 组相比，无病生存率和总生存率相似。建议为年轻成年人开展更多的 CRC 筛查计划，以应对 EOCRC 快速上升的趋势。
