Moore P A, Dilawari R A, Fidler W J
Am Surg. 1984 Jan;50(1):10-4.
Sixty-two patients less than 40 years of age were admitted with adenocarcinoma of the colon and rectum between 1967 and 1981 at the Methodist Hospitals of Memphis. These represented 3.2 per cent of a total of 1909 patients with the disease during the same time period. Eighty-one per cent presented less than 6 months after onset of symptoms; pain and bleeding being the most common complaints. Inflammatory bowel diseases and polyposis were uncommon. Fifty-eight per cent of the lesions were within reach of the sigmoidoscope. Localized disease was present in 37.9 per cent, with one-third presenting with distant metastases. Sixty-five per cent were considered curable at initial laparotomy. Only 2 per cent of the lesions were well differentiated, and mucin production was noted in 32.3 per cent of the specimens compared to 8.6 per cent in the total group. Vascular invasion was noted in 24 per cent and perineural invasion in 11 per cent. Five-year survival was only 17.6 per cent, although this increased to 33 per cent in those undergoing curative resection. Survival in the total group of 1909 patients was 35.5 per cent at 5 years. The poorer survival in the young patients does not seem to be on the basis of delay in diagnosis, premalignant states, or distribution of lesions, but rather it reflects an inherently more virulent lesion. This impression is supported by a greater incidence of mucinous tumors (a poor prognostic indicator) and higher incidence of advanced disease, especially in the second and third decades.
1967年至1981年间，孟菲斯卫理公会医院收治了62例年龄小于40岁的结肠直肠癌患者。这些患者占同期1909例该疾病患者总数的3.2%。81%的患者在症状出现后不到6个月就诊；疼痛和出血是最常见的主诉。炎性肠病和息肉病并不常见。58%的病变在乙状结肠镜检查范围内。37.9%的患者为局限性疾病，其中三分之一伴有远处转移。65%的患者在初次剖腹手术时被认为可治愈。只有2%的病变为高分化，32.3%的标本有黏液产生，而在全部病例组中这一比例为8.6%。24%的病例有血管侵犯，11%有神经周围侵犯。5年生存率仅为17.6%，尽管接受根治性切除的患者这一比例增至33%。1909例患者的总体5年生存率为35.5%。年轻患者较差的生存率似乎并非基于诊断延迟、癌前状态或病变分布，而是反映了一种本质上更具侵袭性的病变。黏液性肿瘤（预后不良指标）的较高发生率以及晚期疾病的较高发生率，尤其是在二三十岁的患者中，支持了这一观点。
