早发性结直肠癌患者各年龄组间生存异质性的研究：基于国家癌症数据库的分析。

Heterogeneity in survival within age groups of early-onset colorectal cancer patients: A National Cancer Database analysis.

机构信息

Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA.

Department of Surgery, University of Port Harcourt Teaching Hospital Port Harcourt, Port Harcourt, Rivers State, Nigeria.

出版信息

J Surg Oncol. 2024 Sep;130(3):622-636. doi: 10.1002/jso.27754. Epub 2024 Sep 5.

DOI:10.1002/jso.27754

PMID:39233561

Abstract

BACKGROUND

We aimed to identify predictors of and heterogeneity in survival among different age groups of patients with early-onset colorectal cancer (EOCRC).

METHODS

This retrospective cohort study used National Cancer Database data from 2004 to 2019. Differences in survival among CRC patients <50 years, subcategorized into age groups (<20, 20-29, 30-39, 40-49 years) were compared for demographic, clinical, and histologic features by univariate and multivariate analyses. Cox hazard regression and Kaplan Meier survival analysis were performed.

RESULTS

134 219 of the 1 240 787 individuals with CRC (10.8%) were <50 years old; 46 639 (34.8%) had rectal and 87 580 (65.3%) had colon cancer. Within the colon cancer cohort, individuals aged between 30 and 39 years had the highest overall survival rate (66.7%) during a median follow-up of 47.6 months (interquartile range IQR 23.1-89.7). The same age group in the rectal cancer cohort had the lowest survival rate (31%) over a median follow-up of 54.5 (IQR 28.24-97.31) months. Leading factors affecting survival included tumor stage (HR 8.23 [4.64-14.6]; p < 0.0001), lymphovascular invasion (HR 1.88 [1.70-2.06]; p < 0.0001) and perineural invasion (HR 1.08 [1.02-1.15]; p = 0.001).

CONCLUSION

Survival trends vary within age groups of patients affected with early onset colon cancer compared to rectal cancer. Tumor stage and unfavorable pathological characteristics are the strongest factors predicting survival.

摘要

背景

本研究旨在确定早发性结直肠癌（EOCRC）不同年龄组患者的生存预测因素和异质性。

方法

这是一项回顾性队列研究，使用了 2004 年至 2019 年国家癌症数据库的数据。通过单因素和多因素分析比较了年龄<50 岁的 CRC 患者（分为<20、20-29、30-39、40-49 岁四个亚组）的生存差异，比较了人口统计学、临床和组织学特征。进行了 Cox 风险回归和 Kaplan-Meier 生存分析。

结果

在 1240787 例 CRC 患者中，有 134219 例（10.8%）<50 岁；其中 46639 例（34.8%）为直肠癌，87580 例（65.3%）为结肠癌。在结肠癌队列中，年龄在 30-39 岁之间的个体在中位随访 47.6 个月（23.1-89.7）期间总体生存率最高（66.7%）。在直肠癌队列中，同一年龄组的生存率最低（31%），中位随访时间为 54.5 个月（28.24-97.31）。影响生存的主要因素包括肿瘤分期（HR 8.23 [4.64-14.6]；p<0.0001）、淋巴血管侵犯（HR 1.88 [1.70-2.06]；p<0.0001）和神经周围侵犯（HR 1.08 [1.02-1.15]；p=0.001）。