Liu Baoqiu, Luo Huilong, Li Bin, Yu Haina, Sun Rui, Li Jibin, Gao Yuanhong, Ding Peirong, Wang Xicheng, Xiao Weiwei
Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651, East Dongfeng Road, Guangzhou 510060, China.
Department of Oncology, The First Affiliated Hospital of Guangdong Pharmaceutical University, 19 Nonglin Xia Road, Yue Xiu, Guangzhou 510080, China.
Ther Adv Med Oncol. 2024 Feb 11;16:17588359241229434. doi: 10.1177/17588359241229434. eCollection 2024.
There is a rapidly increasing incidence of early-onset colorectal cancer (EO-CRC) which threatens the survival of young people, while aging also represents a challenging clinical problem.
We aimed to investigate the differences in the clinical characteristics and prognosis in stage III rectal cancer (RC), to help optimize treatment strategies.
This study included 757 patients with stage III RC, all of whom received neoadjuvant chemoradiotherapy and total mesorectal excision. The whole cohort was categorized as very early onset (VEO, ⩽30 years old), early onset (EO, >30 years old, ⩽50 years old), intermediate onset (IO, >50 years, ⩽70 years), or late onset (LO, >70 years old).
There were more female VEO patients than males, more mucinous adenocarcinoma, signet-ring cell carcinoma, pre-treatment cT4 stage, and higher pre-treatment serum carbohydrate antigen 19-9 compared with the other three groups. VEO patients had the worst survival with the highest RC-related mortality (34.5%), recurrence (13.8%), and metastasis (51.7%). LO patients had the highest non-RC-related mortality rate (16.6%). The Cox regression model showed VEO was a negative independent prognostic factor for disease-free survival [DFS, hazard ratio (HR): 2.830, 95% confidence interval (CI): 1.633-4.904, < 0.001], distant metastasis-free survival (DMFS, HR: 2.969, 95% CI: 1.720-5.127, < 0.001), overall survival (OS, HR: 2.164, 95% CI: 1.102-4.249, = 0.025), and cancer-specific survival (CSS, HR: 2.321, 95% CI: 1.145-4.705, = 0.020). LO was a negative independent factor on DFS (HR: 1.800, 95% CI: 1.113-2.911, = 0.017), DMFS (HR: 1.903, 95% CI: 1.150-3.149, = 0.012), OS (HR: 2.856, 95% CI: 1.745-4.583, < 0.001), and CSS (HR: 2.248, 95% CI: 1.282-3.942, = 0.005). VEO patients had better survival in the total neoadjuvant therapy-like (TNT-like) pattern on DFS ( = 0.039). IO patients receiving TNT-like patterns had better survival on DFS, OS, and CSS ( = 0.006, = 0.018, = 0.006, respectively).
In stage III RC, VEO patients exhibited unique clinicopathological characteristics, with VEO a negative independent prognostic factor for DFS, DMFS, OS, and CSS. VEO and IO patients may benefit from a TNT-like treatment pattern.
早发性结直肠癌（EO-CRC）的发病率正在迅速上升，威胁着年轻人的生存，而老龄化也是一个具有挑战性的临床问题。
我们旨在研究III期直肠癌（RC）临床特征和预后的差异，以帮助优化治疗策略。
本研究纳入757例III期RC患者，所有患者均接受了新辅助放化疗和全直肠系膜切除术。整个队列被分为极早发（VEO，≤30岁）、早发（EO，>30岁，≤50岁）、中年发（IO，>50岁，≤70岁）或晚发（LO，>70岁）。
与其他三组相比，VEO女性患者多于男性，黏液腺癌、印戒细胞癌、治疗前cT4期更多，治疗前血清糖类抗原19-9更高。VEO患者的生存率最差，RC相关死亡率（34.5%）、复发率（13.8%）和转移率（51.7%）最高。LO患者的非RC相关死亡率最高（16.6%）。Cox回归模型显示，VEO是无病生存[DFS，风险比（HR）：2.830，95%置信区间（CI）：1.633-4.904，P<0.001]、无远处转移生存（DMFS，HR：2.969，95%CI：1.720-5.127，P<0.001）、总生存（OS，HR：2.164，95%CI：1.102-4.249，P=0.025）和癌症特异性生存（CSS，HR：2.321，95%CI：1.145-4.705，P=0.020）的负性独立预后因素。LO是DFS（HR：1.800，95%CI：1.113-2.911，P=0.017）、DMFS（HR：1.903，95%CI：1.150-3.149，P=0.012）、OS（HR：2.856，95%CI：1.745-4.583，P<0.001）和CSS（HR：2.248，95%CI：1.282-3.942，P=0.005）的负性独立因素。VEO患者在类全新辅助治疗（TNT样）模式下DFS的生存率更好（P=0.039）。接受TNT样模式的IO患者在DFS、OS和CSS方面的生存率更好（分别为P=0.006、P=0.018、P=0.006）。
在III期RC中，VEO患者表现出独特的临床病理特征，VEO是DFS、DMFS、OS和CSS的负性独立预后因素。VEO和IO患者可能从TNT样治疗模式中获益。
