Aldriwesh Marwh G, Aljaian Amer R, Alorf Khalid M, Bayounis Mohammed A, Alrayani Yazeed H, Philip Winnie, Algarni Mohammed, Alselaim Nahar A, Alotibi Raniah S
Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
Front Oncol. 2024 Dec 5;14:1460636. doi: 10.3389/fonc.2024.1460636. eCollection 2024.
Recent studies have shown an increase in the prevalence of early-onset colorectal cancer (CRC) in people aged 20-49 compared to those aged 50-74, with a more rapid increase in the younger age groups. Poorly differentiated, left-sided, and rectal tumors were more common in young adults than in older adult CRC patients. We aimed to improve the understanding of early-onset CRC and to guide primary care physicians on strategies to mitigate its impact.
Adult patients with CRC identified within 2015-2022 were recruited and divided into young adult-onset (CRC identified at age ≤49 years) and older adult-onset (CRC identified at age ≥50 years). Clinical data were retrieved from electronic medical records, then analyzed. Multivariable analyses were performed to predict the CRC prognosis in both age groups.
The study cohort had 530 patients categorized into young adult (n=98; 18.5%) and older adult (n=432; 81.5%). Higher proportions of family histories of CRC, other malignancies, and inflammatory bowel disease in the young adult group were observed (P<0.05). Gastrointestinal symptoms mainly abdominal pain and nausea were more often identified in the young adults. Mucinous adenocarcinoma, signet ring cells, and poorly differentiated tumors were higher in the young adults (P<0.05). Lymphovascular invasion was an independent predictor for advanced stage CRC (AOR 8.638, 95%CI 2.152-34.673, P=0.002 for young adults and AOR 21.757, 95%CI 10.025-47.219, P=0.001 for older adults). Further, the mucinous (AOR 3.727, 95%CI 1.937-7.173, P=0.001 for young adults and AOR 3.534, 95%CI 1.698-7.354, P=0.001 for older adults) and lymphovascular invasion (AOR 3.371, 95%CI 2.107-5.393, P=0.001 for young adults and AOR 3.246, 95%CI 1.910-5.517, P=0.001 for older adults) were independent predictors for recurrence/late metastasis in both age groups.
We recommended to raise awareness among healthcare providers of the importance of lowering the threshold of suspicion in young people presenting with worrisome gastrointestinal symptoms. Our findings suggested the importance of reconsidering the current CRC screening guidelines to lower the threshold of the recommended starting age.
最近的研究表明，与50 - 74岁的人群相比，20 - 49岁人群中早发性结直肠癌（CRC）的患病率有所上升，且在较年轻年龄组中上升更为迅速。低分化、左侧和直肠肿瘤在年轻成年CRC患者中比在老年成年患者中更为常见。我们旨在增进对早发性CRC的理解，并指导初级保健医生采取策略减轻其影响。
招募2015 - 2022年内确诊的成年CRC患者，并分为年轻成年发病组（年龄≤49岁时确诊CRC）和老年成年发病组（年龄≥50岁时确诊CRC）。从电子病历中检索临床数据，然后进行分析。进行多变量分析以预测两个年龄组的CRC预后。
研究队列中有530名患者，分为年轻成年组（n = 98；18.5%）和老年成年组（n = 432；81.5%）。观察到年轻成年组中CRC家族史、其他恶性肿瘤和炎症性肠病的比例更高（P < 0.05）。年轻成年人中更常发现胃肠道症状，主要是腹痛和恶心。年轻成年人中黏液腺癌、印戒细胞和低分化肿瘤的比例更高（P < 0.05）。淋巴管浸润是晚期CRC的独立预测因素（年轻成年人的优势比为8.638，95%置信区间为2.152 - 34.673，P = 0.002；老年成年人的优势比为21.757，95%置信区间为10.025 - 47.219，P = 0.001）。此外，黏液性（年轻成年人的优势比为3.727，95%置信区间为1.937 - 7.173，P = 0.001；老年成年人的优势比为3.534，95%置信区间为1.698 - 7.354，P = 0.001）和淋巴管浸润（年轻成年人的优势比为3.371，95%置信区间为2.107 - 5.393，P = 0.001；老年成年人的优势比为3.246，95%置信区间为1.910 - 5.517，P = 0.001）是两个年龄组复发/晚期转移的独立预测因素。
我们建议提高医疗保健提供者对降低对出现令人担忧的胃肠道症状的年轻人的怀疑阈值的重要性的认识。我们的研究结果表明重新考虑当前CRC筛查指南以降低推荐起始年龄阈值的重要性。
