Colorectal cancer outcomes and treatment patterns in patients too young for average-risk screening.
Colorectal cancer outcomes and treatment patterns in patients too young for average-risk screening.
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DOI：
10.1002/cncr.29716
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发表时间：
2016-03-15
期刊：
影响因子：
6.2
通讯作者：
Hendren S
中科院分区：
文献类型：
--
作者：
Abdelsattar ZM;Wong SL;Regenbogen SE;Jomaa DM;Hardiman KM;Hendren S
尽管结直肠癌（CRC）筛查指南建议从50岁开始，但年轻患者的癌症病例比例正在增加。这些患者的国家治疗模式和结果在很大程度上是未知的。这是一项基于人群的回顾性队列研究，对1998-2011年诊断为CRC的患者进行了全国代表性的监测、流行病学和最终结果登记。患者被分类为比推荐的筛选年龄更年轻或更年长。采用多项回归、多元回归、Cox比例风险回归和Weibull生存分析，比较不同年龄组在诊断分期、治疗模式和疾病特异性生存率方面的差异。在258，024例CRC患者中，37，847例（15%）年龄小于50岁。年轻患者更可能出现局部（相对危险比[RRR]：1.3，p<0.001）或远处（RRR：1.5，p<0.001）疾病。在较年轻的年龄组中，有远处转移的CRC患者更有可能接受原发肿瘤的手术治疗（校正概率：72% vs. 63%; p<0.001），放射治疗更有可能在较年轻的RC患者中进行（校正概率：53% vs. 48%; p<0.001）。年龄小于筛查年龄的患者有更好的总体疾病特异性生存率（风险比：0.77; p<0.001），尽管有更大比例的晚期疾病。在50岁之前诊断的结直肠癌患者更有可能出现晚期疾病。然而，他们接受更积极的治疗，并实现更长的疾病特异性生存期，尽管更大比例的晚期疾病。这些研究结果表明，需要改善年轻人的风险评估和筛查决策。
The proportion of cancer cases in younger patients is increasing though colorectal cancer (CRC) screening guidelines recommend starting at age 50. The national treatment patterns and outcomes of these patients are largely unknown. This is a population-based retrospective cohort study of the nationally representative Surveillance, Epidemiology, and End Results registry for patients diagnosed with CRC from 1998-2011. Patients were categorized as being younger or older than the recommended screening age. Differences in stage at diagnosis, patterns of therapy, and disease-specific survival were compared between age groups using multinomial regression, multiple regression, cox-proportional hazards regression, and Weibull survival analysis. Of 258,024 CRC patients, 37,847 (15%) were younger than 50. Young patients were more likely to present with regional (Relative risk ratio [RRR]: 1.3, p<0.001) or distant (RRR: 1.5, p<0.001) disease. CRC patients with distant metastasis were more likely to receive surgical therapy for their primary tumor in the younger age group (adjusted probability: 72% vs. 63%; p<0.001), and radiation therapy was more likely in younger RC patients (adjusted probability: 53% vs. 48%; p<0.001). Patients younger than screening age had better overall disease-specific survival (Hazard ratio: 0.77; p<0.001), despite a larger proportion presenting with advanced disease. Colorectal cancer patients diagnosed before age 50 are more likely to present with advanced stage disease. However, they receive more aggressive therapy and achieve longer disease-specific survival, despite the greater proportion with advanced-stage disease. These findings suggest the need for improved risk assessment and screening decisions for younger adults.