早发型与晚发型散发性结直肠癌的预后：系统评价与荟萃分析。

Prognosis of early-onset versus late-onset sporadic colorectal cancer: Systematic review and meta-analysis.

作者信息

Carbone Fabio, Spinelli Antonino, Ciardiello Davide, Realis Luc Marco, de Pascale Stefano, Bertani Emilio, Fazio Nicola, Fumagalli Romario Uberto

机构信息

Digestive Surgery, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, Milan 20141, Italy.

Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan 20072, Italy; Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan 20089, Italy.

出版信息

Eur J Cancer. 2025 Jan 17;215:115172. doi: 10.1016/j.ejca.2024.115172. Epub 2024 Dec 7.

DOI:10.1016/j.ejca.2024.115172

PMID:39681013

Abstract

BACKGROUND

In the last years, a dramatic increase in colorectal cancer (CRC) diagnoses in early-onset (EO) patients has been observed. The prognosis of EO-CRC compared to late-onset (LO) patients is still unclear. This meta-analysis aims to clarify whether there is any difference in the prognosis between the two groups.

METHODS

A systematic review was conducted on EMBASE-Medline, Pubmed and Cochrane Library in March 2024 to identify studies comparing overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), local recurrence (LR) and distant recurrence (DR) risk outcomes between EO-CRC (<50 years old) and LO-CRC (>50 years old) with at least 50 patients per group and one year of follow-up. The risk of bias was assessed with the ROBINS-E tool. Data from stage prevalence and survival were extracted and meta-analysed. Meta-regression was used to identify impacting effect modifiers. The PROSPERO registration number was CRD42024573264.

RESULTS

Twenty-six studies were identified; 1,062,037 patients (13.4% EO-CRC and 86.6% LO-CRC) were included in the stage prevalence and 567,689 in the prognostic meta-analysis. Overall, 60% of the EO-CRC and 49% of the LO-CRC were diagnosed with an advanced stage (III-IV) of disease (RR 1.26, 95%CI 1.19-1.35, I=87%). EO-CRC had a better OS than LO-CRC (HR 0.89, 95%CI 0.81-0.99, I=89%) but equal CSS (HR 0.94, 95%CI 0.83-1.06, I=82%), DFS (HR 1.05 95%CI 0.94-1.16, I=76%), LR (HR 1.41, 95%CI 0.62-3.18, I=49%) and DR (HR 1.51, 95%CI 0.79-2.89) risk. Meta-regression analysis identified a worse DFS in the EO-CRC rectal cancer subgroup (HR 1.14, 95%CI 1.00-1.30, I=0%).

CONCLUSIONS

Despite the high heterogeneity of existing studies, EO-CRC patients are diagnosed with significantly more advanced stages than LO-CRC, although this is not reflected in any difference in cancer-related survival. There is an urgent need for increased vigilance in the early detection of CRC in young patients.

摘要

背景

在过去几年中，早发性（EO）结直肠癌患者的诊断数量急剧增加。与晚发性（LO）患者相比，EO-CRC的预后仍不清楚。本荟萃分析旨在阐明两组之间的预后是否存在差异。

方法

2024年3月对EMBASE-Medline、Pubmed和Cochrane图书馆进行了系统评价，以确定比较EO-CRC（<50岁）和LO-CRC（>50岁）之间总生存期（OS）、癌症特异性生存期（CSS）、无病生存期（DFS）、局部复发（LR）和远处复发（DR）风险结果的研究，每组至少50例患者，随访1年。使用ROBINS-E工具评估偏倚风险。提取并对来自阶段患病率和生存期的数据进行荟萃分析。使用荟萃回归来确定影响效应修饰因素。PROSPERO注册号为CRD42024573264。

结果

共纳入26项研究；1,062,037例患者（13.4%为EO-CRC，86.6%为LO-CRC）纳入阶段患病率分析，567,689例纳入预后荟萃分析。总体而言，60%的EO-CRC和49%的LO-CRC被诊断为疾病晚期（III-IV期）（RR 1.26，95%CI 1.19-1.35，I=87%）。EO-CRC的OS优于LO-CRC（HR 0.89，95%CI 0.81-0.99，I=89%），但CSS（HR 0.94，95%CI 0.83-1.06，I=82%）、DFS（HR 1.05，95%CI 0.94-1.16，I=76%）、LR（HR 1.41，95%CI 0.62-3.18，I=49%）和DR（HR 1.51，95%CI 0.79-2.89）风险相当。荟萃回归分析发现EO-CRC直肠癌亚组的DFS较差（HR 1.14，95%CI 1.00-1.30，I=0%）。