Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an, China.
Department of Neurology, Airborne Army Hospital, Wuhan, China.
Sci Rep. 2024 Nov 9;14(1):27335. doi: 10.1038/s41598-024-76951-4.
The incidence of Early-Onset Colorectal Cancer (EOCRC) is increasing. However, the prognosis of EOCRC compared to Late-Onset Colorectal Cancer (LOCRC), and the ideal age for initial colorectal cancer (CRC) screening are not clear. In this study, we identified the pathological differences between the groups and determined the optimal screening age for CRC patients. We included 10,172 patients diagnosed with CRC from January 2011 to December 2021 in this study. Survival differences were compared by plotting Kaplan-Meier survival curves and conducting landmark analysis. Additionally, the diagnostic age of CRC patients was analyzed using age cumulative curves. Compared to LOCRC patients, EOCRC patients had a higher proportion of deficient mismatch repair (dMMR) and more advanced TNM staging (P < 0.05). The five-year survival of EOCRC patients was significantly better than that of LOCRC patients (P < 0.05). Laparoscopic surgery improved the long-term survival of EOCRC patients. Proficient mismatch repair (pMMR) favored the long-term survival of EOCRC patients. The survival rate of EOCRC patients at TNM stages I and II was higher than that of LOCRC patients at the same stages (P < 0.05). The age cumulative curve showed a substantial increase in the number of CRC patients at 40 years. The long-term prognosis of EOCRC patients is better than that of LOCRC patients, especially among those with pMMR, stages I-II, and who undergo laparoscopic surgery. For people with a high risk of cancer, such as a family history of cancer and poor lifestyle habits, the starting age for CRC screening should be 40 years.
早发性结直肠癌（EOCRC）的发病率正在增加。然而，EOCRC 的预后与晚发性结直肠癌（LOCRC）相比，以及理想的结直肠癌（CRC）初始筛查年龄尚不清楚。在这项研究中，我们确定了两组之间的病理差异，并确定了 CRC 患者的最佳筛查年龄。我们纳入了 10172 例 2011 年 1 月至 2021 年 12 月期间诊断为 CRC 的患者。通过绘制 Kaplan-Meier 生存曲线和进行 landmark 分析比较生存差异。此外，还使用年龄累积曲线分析了 CRC 患者的诊断年龄。与 LOCRC 患者相比，EOCRC 患者的错配修复缺陷（dMMR）比例更高，TNM 分期更晚期（P<0.05）。EOCRC 患者的五年生存率明显优于 LOCRC 患者（P<0.05）。腹腔镜手术改善了 EOCRC 患者的长期生存。 proficient mismatch repair（pMMR）有利于 EOCRC 患者的长期生存。EOCRC 患者在 TNM Ⅰ期和Ⅱ期的生存率高于 LOCRC 患者在同一阶段的生存率（P<0.05）。年龄累积曲线显示 40 岁时 CRC 患者数量明显增加。EOCRC 患者的长期预后优于 LOCRC 患者，尤其是在 pMMR、Ⅰ期和Ⅱ期和接受腹腔镜手术的患者中。对于癌症风险较高的人群，如癌症家族史和不良生活习惯，CRC 筛查的起始年龄应为 40 岁。
