Cusack J C, Giacco G G, Cleary K, Davidson B S, Izzo F, Skibber J, Yen J, Curley S A
Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
J Am Coll Surg. 1996 Aug;183(2):105-12.
We sought to determine the clinical factors and tumor characteristics associated with the reported poor prognosis in young patients with carcinoma of the colon and rectum.
A retrospective review was performed of 186 patients younger than 40 years of age who were treated for primary colorectal adenocarcinoma. The median age was 34.3 years, and the median follow-up period was 9.4 years. Clinical and tumor histopathologic parameters were analyzed.
Regional lymph node metastases, distant metastases, or both, were seen at first examination in 65.6 percent of young patients. Histopathologic indicators of more aggressive tumor biology were present at a significantly higher frequency in young patients compared with patients older than 40 years (p < 0.001). Poorly differentiated tumor grade was present in 41.0 percent, signet-ring cell tumors were found in 11.1 percent, and infiltrating tumor leading edges were present in 69.0 percent of young patients. Among young patients with stage II disease, vascular invasion was a significant negative prognostic variable (p < 0.05).
We have demonstrated an increased incidence of three biological indicators of aggressive and potentially metastatic tumor biology in 186 young patients with carcinoma of the colon and rectum: signet-ring cell carcinoma, infiltrating tumor edges, and aggressive histologic grade in the primary adenocarcinoma. The increased incidence of these three histologic measures of more aggressive carcinoma of the colon and rectum in part accounts for the higher rate of advanced disease at presentation in patients younger than 40.
我们试图确定与报道的年轻结肠直肠癌患者预后不良相关的临床因素和肿瘤特征。
对186例年龄小于40岁的原发性结肠直肠癌患者进行回顾性研究。中位年龄为34.3岁，中位随访期为9.4年。分析临床和肿瘤组织病理学参数。
65.6%的年轻患者在初次检查时出现区域淋巴结转移、远处转移或两者皆有。与40岁以上患者相比，年轻患者中具有更具侵袭性肿瘤生物学行为的组织病理学指标出现频率显著更高（p<0.001）。41.0%的年轻患者存在低分化肿瘤分级，11.1%发现印戒细胞肿瘤，69.0%的年轻患者存在浸润性肿瘤前沿。在II期疾病的年轻患者中，血管侵犯是一个显著的不良预后变量（p<0.05）。
我们已证实在186例年轻结肠直肠癌患者中，具有侵袭性和潜在转移性肿瘤生物学行为的三个生物学指标的发生率增加：印戒细胞癌、浸润性肿瘤边缘以及原发性腺癌的侵袭性组织学分级。结肠直肠癌这三种更具侵袭性组织学表现发生率的增加部分解释了40岁以下患者就诊时晚期疾病发生率较高的原因。
