Department of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology, and Medical Oncology, Ordensklinikum Linz, Linz, Austria.
Department of Internal Medicine I, Wilhelminenspital, Wien, Austria.
Oncology. 2024;102(2):107-113. doi: 10.1159/000533429. Epub 2023 Sep 12.
Survival of patients suffering from metastatic colorectal cancer (mCRC) has increased over the last decades. These benefits appear to be restricted to patients aged 50 and above. However, among the population aged <50, colorectal cancer incidence and mortality rates are significantly rising. The clinical benefit of treatment in this population still is a matter of debate. We aim to compare the clinical outcome between patients aged 50 and younger.
In this retrospective, observational study, we analyzed data from 1,077 patients treated for mCRC at three cancer centers in Austria from January 2005 to December 2019. Patients were divided into two groups based on age at diagnosis: <50 years (eo-CRC) and >50 years (regular-onset CRC, ro-CRC). Propensity score matching was used to control for potential biases, and survival outcomes were compared between the two groups.
The differences in tumor characteristics between eo-CRC and ro-CRC in the overall population were primarily related to tumor sidedness and disease-free survival following intended curative resection. Our data show that eo-CRC patients underwent metastases resection more often and received significantly more lines of treatment in the palliative setting. Overall survival was superior in eo-CRC compared to ro-CRC, even after adjusting for sidedness, timing of metastases, sex, number of treatment lines, and resection of metastases by propensity scoring.
Our study suggests that younger patients benefit at least to the same magnitude or even more from mCRC-treatment than patients aged 50 or above.
在过去几十年中，转移性结直肠癌（mCRC）患者的生存率有所提高。这些益处似乎仅限于 50 岁及以上的患者。然而，在 50 岁以下的人群中，结直肠癌的发病率和死亡率正在显著上升。该人群的治疗临床获益仍然存在争议。我们旨在比较 50 岁及以下患者的临床结局。
在这项回顾性观察性研究中，我们分析了 2005 年 1 月至 2019 年 12 月在奥地利三家癌症中心接受 mCRC 治疗的 1077 名患者的数据。患者根据诊断时的年龄分为两组：<50 岁（eo-CRC）和>50 岁（常规发病 CRC，ro-CRC）。使用倾向评分匹配来控制潜在偏倚，并比较两组之间的生存结果。
总体人群中 eo-CRC 和 ro-CRC 之间肿瘤特征的差异主要与肿瘤侧别和预期根治性切除后无病生存有关。我们的数据表明，eo-CRC 患者更频繁地进行转移灶切除术，并在姑息治疗中接受了更多线的治疗。即使在调整了侧别、转移时间、性别、治疗线数和转移灶切除后，eo-CRC 的总生存期仍优于 ro-CRC。
我们的研究表明，年轻患者从 mCRC 治疗中获益的程度至少与 50 岁及以上的患者相同，甚至更多。
