Chen Fan, Chen Jiayu, Luo Dakui, Zhang Ruijia, Yang Yufei, Li Qingguo, Li Xinxiang
Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
J Gastroenterol Hepatol. 2025 Jan;40(1):133-141. doi: 10.1111/jgh.16792. Epub 2024 Nov 3.
The risk of developing a second primary malignancy differs among colorectal cancer patients in different age groups. This study aimed to investigate the differences in prognosis and clinicopathological features of patients with early-onset colorectal cancer and late-onset colorectal cancer who developed second primary malignancies.
The study included 15 489 patients who underwent surgery for colorectal cancer at Fudan University Shanghai Cancer Center between January 2008 and December 2018. Data pertaining to these patients were derived from the database.
A total of 680 (4.5%) patients subsequently developed a second primary malignancy. Considering death as a competing event, the 10-year cumulative risk of second primary malignancy for early-onset colorectal cancer was 5.3%, compared with 7.3% for late-onset colorectal cancer. Cox analysis showed that late-onset colorectal cancer, colon cancer, smaller tumor size, and fewer tumor nodules without residual lymph node structure, chemotherapy, and radiotherapy were independent risk factors for second primary malignancy. In our patient cohort, early-onset colorectal cancer was associated with better prognosis compared to late-onset colorectal cancer, for both overall survival and second primary malignancy-free survival. In addition, there was insufficient evidence that early-onset colorectal cancer also affected prognosis after the occurrence of second primary malignancies.
The risk of early-onset colorectal cancer subsequently developing second primary malignancy was significantly lower than late-onset colorectal cancer, and the second primary malignancies of early-onset colorectal cancer were more likely to be colorectal cancer. Overall survival and second primary malignancy-free survival of early-onset colorectal cancer were consistently better than late-onset colorectal cancer.
不同年龄组的结直肠癌患者发生第二原发性恶性肿瘤的风险存在差异。本研究旨在调查发生第二原发性恶性肿瘤的早发型和晚发型结直肠癌患者在预后及临床病理特征方面的差异。
本研究纳入了2008年1月至2018年12月期间在复旦大学附属肿瘤医院接受结直肠癌手术的15489例患者。这些患者的数据来源于数据库。
共有680例（4.5%）患者随后发生了第二原发性恶性肿瘤。将死亡视为竞争事件，早发型结直肠癌患者发生第二原发性恶性肿瘤的10年累积风险为5.3%，而晚发型结直肠癌患者为7.3%。Cox分析显示，晚发型结直肠癌、结肠癌、肿瘤体积较小、无残留淋巴结结构的肿瘤结节较少、化疗和放疗是第二原发性恶性肿瘤的独立危险因素。在我们的患者队列中，早发型结直肠癌患者在总生存期和无第二原发性恶性肿瘤生存期方面的预后均优于晚发型结直肠癌患者。此外，没有足够的证据表明早发型结直肠癌也会影响第二原发性恶性肿瘤发生后的预后。
早发型结直肠癌随后发生第二原发性恶性肿瘤的风险显著低于晚发型结直肠癌，且早发型结直肠癌的第二原发性恶性肿瘤更有可能是结直肠癌。早发型结直肠癌的总生存期和无第二原发性恶性肿瘤生存期始终优于晚发型结直肠癌。
