Department of Medicine, Mayo Clinic and Mayo Alix School of Medicine, Rochester, Minnesota.
Department Oncology, Mayo Clinic and Mayo Alix School of Medicine, Rochester, Minnesota.
JAMA Netw Open. 2023 Jul 3;6(7):e2324038. doi: 10.1001/jamanetworkopen.2023.24038.
The incidence of early-onset colorectal cancer (CRC) (age, <50 years) continues to increase globally within high-income countries.
To examine and compare rates of synchronous neoplasia found in patients at colonoscopic diagnosis of early-onset CRC with rates found at diagnosis of average-onset CRC.
DESIGN, SETTING, AND PARTICIPANTS: In this multisite retrospective and cross-sectional study conducted at Mayo Clinic sites and in the Mayo Clinic Health System from January 1, 2012, to December 31, 2022, 150 randomly selected patients with early-onset CRC were identified from the electronic health record and matched with 150 patients with average-onset CRC based on sex and colonoscopic indication. Patients with known hereditary syndromes, past history of CRC, or inflammatory bowel disease were excluded.
Colonoscopic findings (polyp size, number, site) and related histopathologic findings (adenoma, advanced adenoma, sessile serrated polyp) were analyzed in association with cancer clinicopathologic features and molecular data (mismatch repair status, KRAS, and BRAFV600E).
Among 300 patients (156 men [52%]), the median age at diagnosis was 43 years (IQR, 39-47 years) for those with early-onset CRC and 67 years (IQR, 57-76) for those with average-onset CRC. Overall, 85% of patients were symptomatic at CRC diagnosis. Cancer stage, grade, molecular features, body mass index, and family history did not differ significantly between these groups. Among patients with colon cancer, the overall prevalence of synchronous neoplasia was similar, yet advanced adenomas were 3 times more frequent in those with early-onset vs average-onset cancers (31 of 75 [41%] vs 10 of 75 [13%]; P < .001). This difference was not associated with cancer stage or primary location. Among patients with rectal cancer, nonadvanced adenomas were less frequent among the early-onset group than the average-onset group (21 of 75 [28%] vs 36 of 75 [48%]), and although the prevalence of advanced adenomas was similar (11 of 75 [15%] vs 14 of 75 [19%]), they were more commonly located in the rectum (early onset, 5 of 11 [45%] vs average onset, 1 of 14 [7%]). Patients with early-onset cancer of the colon were significantly more likely than those with early-onset cancer of the rectum to have a synchronous advanced adenoma (31 of 75 [41%] vs 11 of 75 [15%]; P < .001).
In this cross-sectional study, synchronous advanced adenomas were more commonly found in patients with early-onset colon cancer compared with average-onset colon cancer, and they were distributed throughout the colon. In contrast, advanced adenomas were not increased in patients with rectal cancer and, when detected, were predominantly located in the rectum.
在高收入国家，早期结直肠癌（CRC）（年龄<50 岁）的发病率继续在全球范围内增加。
检查并比较结肠镜诊断早期 CRC 患者与普通发病 CRC 患者中同时发现的肿瘤的发生率。
设计、地点和参与者：这是一项在梅奥诊所和梅奥诊所医疗系统进行的多地点回顾性和横断面研究，从 2012 年 1 月 1 日至 2022 年 12 月 31 日，从电子病历中随机选择了 150 例早期 CRC 患者，并根据性别和结肠镜检查指征与 150 例普通发病 CRC 患者进行匹配。排除已知遗传性综合征、CRC 病史或炎症性肠病的患者。
分析结肠镜检查结果（息肉大小、数量、部位）和相关组织病理学结果（腺瘤、高级别腺瘤、无蒂锯齿状息肉）与癌症临床病理特征和分子数据（错配修复状态、KRAS 和 BRAFV600E）的关系。
在 300 名患者（156 名男性[52%]）中，早期 CRC 患者的中位诊断年龄为 43 岁（IQR，39-47 岁），普通发病 CRC 患者的中位诊断年龄为 67 岁（IQR，57-76 岁）。总体而言，85%的患者在 CRC 诊断时出现症状。这些组之间的癌症分期、分级、分子特征、体重指数和家族史无显著差异。在结肠癌患者中，总体同时性肿瘤的发生率相似，但早期发病的高级别腺瘤发生率是普通发病的 3 倍（31/75[41%]比 10/75[13%]；P<.001）。这种差异与癌症分期或原发部位无关。在直肠癌患者中，早期发病组的非高级别腺瘤比普通发病组少（21/75[28%]比 36/75[48%]），尽管高级别腺瘤的患病率相似（11/75[15%]比 14/75[19%]），但它们更常见于直肠（早期发病组，5/11[45%]比普通发病组，1/14[7%]）。与早期发病的直肠癌患者相比，早期发病的结肠癌患者更有可能同时发生高级别腺瘤（31/75[41%]比 11/75[15%]；P<.001）。
在这项横断面研究中，与普通发病的结肠癌相比，早期发病的结肠癌患者中更常发现同时性高级别腺瘤，且分布于整个结肠。相比之下，直肠癌患者中高级别腺瘤并不增加，而且当发现时，主要位于直肠。
