Inverse Association of Age with Risk of Lymph Node Metastasis in Superficial Colorectal Cancer: A Large Population-Based Study
Inverse Association of Age with Risk of Lymph Node Metastasis in Superficial Colorectal Cancer: A Large Population-Based Study
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年龄与浅表性结直肠癌淋巴结转移风险的负相关：一项基于大规模人群的研究
DOI：
10.1634/theoncologist.2019-0815
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发表时间：
2020-01-10
期刊：
影响因子：
5.8
通讯作者：
Ge, Zhi-Zheng
中科院分区：
文献类型：
--
作者：
Zhang, Qing-Wei;Sun, Long-Ci;Ge, Zhi-Zheng
背景浅表性结直肠癌（SCRC）是指局限于粘膜或粘膜下层的结直肠癌（CRC）。内镜切除术（ER）广泛用于切除来自无淋巴结转移（LNM）患者的分化型SCRC。然而，目前尚不清楚ER是否适用于分化型早发型SCRC患者，因为早发型CRC更具侵袭性。因此，我们的目的是研究结直肠癌发病年龄与淋巴结转移之间的关系。材料与方法我们从监测、流行病学和最终结果（SEER）数据库中检索了手术切除的分化型SCRCs患者的数据。比较18-39、40-49、50-59、60-69和≥ 70岁患者的LNM发生率。年龄和LNM之间的关系进一步采用多因素Logistic回归分析。结果我们从SEER数据库中检索到34，506例分化型SCRCs记录，其中18-39岁667例，40-49岁2，385例，50-59岁8，075例，60-69岁9，577例，≥ 70岁13，802例。18-39岁、40-49岁、50-59岁、60-69岁和≥ 70岁患者的LNM发生率分别为15.74%、14.13%、10.67%、8.07%和6.76%。单因素分析发现，诊断时年龄与淋巴结转移风险呈负相关（p <0.001）。与18-39岁患者相比，40-49岁、50-59岁、60-69岁和≥ 70岁患者的优势比（95%置信区间（CI））为0.90（0.71-1.15，p = .376）、0.69（0.56-0.87，p = .001）、0.54（0.43-0.68，p < .001）和0.47（0.38-0.60，p < .001）。结论在分化型SCRCs中，诊断时年龄越小，LNM的风险越高。内镜切除术（ER）被广泛用于切除无淋巴结转移（LNM）的分化型浅表性结直肠癌（SCRC）。然而，没有研究曾经调查的风险LNM的早发性SCRC相比，平均发病的SCRC，以探讨是否ER是适合早发性SCRC。据作者所知，这项基于人群的研究是第一项发现诊断年龄与分化型SCRCs中LNM风险之间负相关的研究。这一发现表明ER可能不适合年轻的分化型SCRC患者。由于手术后30天的手术死亡率较高，但与年轻患者相比，老年患者的LNM风险较低，因此分化型SCRCs的ER可能优于老年患者的手术。
Background Superficial colorectal cancer (SCRC) is defined as colorectal cancer (CRC) confined to the mucosa or submucosa. Endoscopic resection (ER) is widely used to resect differentiated SCRC from patients without lymph node metastasis (LNM). However, it is unclear whether ER is suitable for use with patients with differentiated early-onset SCRC because early-onset CRC is more aggressive. Therefore, we aimed to investigate the association between age of CRC onset and LNM. Materials and Methods We retrieved data for patients with surgically resected differentiated-type SCRCs from the Surveillance, Epidemiology, and End Results (SEER) database. Rate of LNM was compared among patients aged 18-39, 40-49, 50-59, 60-69, and >= 70 years. The association between age and LNM was further examined using multivariate logistic regression. Results We retrieved 34,506 records of differentiated SCRCs from the SEER database, including 667 patients aged 18-39 years, 2,385 aged 40-49, 8,075 aged 50-59 years, 9,577 aged 60-69 years, and 13,802 aged >= 70 years. Rates of LNM were 15.74%, 14.13%, 10.67%, 8.07%, and 6.76% for patients aged 18-39, 40-49, 50-59, 60-69, and >= 70 years, respectively. We found an inverse correlation between age at diagnosis and risk of LNM from the univariate analysis (p < .001). Compared with patients aged 18-39, the odds ratios with 95% confidence interval (CI) for patients aged 40-49, 50-59, 60-69, and >= 70 years were 0.90 (0.71-1.15, p = .376), 0.69 (0.56-0.87, p = .001), 0.54 (0.43-0.68, p < .001), and 0.47 (0.38-0.60, p < .001), respectively. Conclusion In differentiated SCRCs, younger age at diagnosis was associated with higher risk of LNM. Implications for Practice Endoscopic resection (ER) is widely used to resect differentiated superficial colorectal cancer (SCRC) without lymph node metastasis (LNM). However, no study has ever investigated risk of LNM of early-onset SCRC compared with average onset SCRC to explore whether ER is suitable for early-onset SCRC. To the authors' knowledge, this population-based study is the first study to find inverse correlation between age at diagnosis and risk of LNM in differentiated SCRCs. This finding indicates that ER may not be suitable for young patients with differentiated SCRC. Because the 30-day operative mortality after surgery is higher but the risk of LNM is lower in older patients compared with younger patients, ER for differentiated SCRCs may be advantageous over surgery for older patients.