Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
Cancer Med. 2023 Feb;12(3):3433-3441. doi: 10.1002/cam4.5120. Epub 2022 Aug 5.
The incidence of colorectal cancer is increasing among young adults and more rectal cancers are reported. This study aimed to identify the clinical features specific for early-onset rectal cancer and provide insights on cancer management.
Early-onset (<50 years) and late-onset (≥50 years) rectal cancer patients from a referral tertiary care center (SYSU cohort) and Surveillance Epidemiology and End Results database (SEER cohort) were included to perform a comprehensive comparison on clinical information.
A total of 552 and 80,341 patients with stages I-III rectal cancer were included in the SYSU and SEER cohorts, respectively. In the SYSU cohort, early-onset diseases had significantly higher prevalence of family history of cancer and history of HBV infection and lower incidence of comorbidities (p < 0.05). In addition, early-onset patients presented more frequently with advanced node stage (N2 stage: 16.9 vs. 9.3%, p = 0.017) and high-risk features, including mucinous or signet cell carcinomas (21.8 vs. 12.9%, p = 0.014), poorly differentiated tumors (28.8 vs. 15.4%, p = 0.002), and perineural invasion (14.5 vs. 7.9%, p = 0.027) compared with late-onset patients. However, early-onset patients received more neoadjuvant (18.5 vs. 11.2%, p = 0.032) and adjuvant treatments (71.0 vs. 45.8%, p < 0.001), and they had better overall survival in both SYSU (HR 0.57, 95% CI: 0.34-0.95; p = 0.029) and SEER (HR 0.38, 95% CI: 0.37-0.40; p < 0.001) cohorts.
Early-onset rectal cancers are distinct from late-onset cases in clinicopathological features, treatment modalities, and outcomes. The clinical trials and studies that are specific for young populations are needed to develop optimal strategies for cancer screening, treatment, and surveillance.
结直肠癌在年轻人中的发病率正在上升，且更多的直肠癌被报道。本研究旨在确定早期直肠癌的特定临床特征，并为癌症管理提供见解。
本研究纳入了来自一家转诊三级保健中心（中山大学队列）和监测、流行病学和最终结果数据库（SEER 队列）的早期（<50 岁）和晚期（≥50 岁）直肠癌患者，以对临床信息进行全面比较。
中山大学队列共纳入 552 例 I-III 期直肠癌患者，SEER 队列纳入 80,341 例直肠癌患者。中山大学队列中，早发疾病的癌症家族史和乙肝病毒感染史发生率较高，合并症发生率较低（p<0.05）。此外，早发患者更常出现进展期淋巴结转移（N2 期：16.9%比 9.3%，p=0.017）和高危特征，包括黏液腺癌或印戒细胞癌（21.8%比 12.9%，p=0.014）、低分化肿瘤（28.8%比 15.4%，p=0.002）和神经周围侵犯（14.5%比 7.9%，p=0.027）。然而，早发患者接受新辅助治疗（18.5%比 11.2%，p=0.032）和辅助治疗（71.0%比 45.8%，p<0.001）的比例更高，且在中山大学和 SEER 队列中均有更好的总生存（HR 0.57，95%CI：0.34-0.95；p=0.029）和（HR 0.38，95%CI：0.37-0.40；p<0.001）。
早发直肠癌在临床病理特征、治疗方式和结局上与晚发病例不同。需要针对年轻人群开展特定的临床试验和研究，以制定最佳的癌症筛查、治疗和监测策略。
