Background: Early-onset colorectal cancer (EO-CRC) is defined as colorectal cancer diagnosed before the age of 50 years, and its incidence has been increasing over the last decade, now accounting for 10% of all new CRC diagnoses. Average-onset colorectal cancer (AO-CRC) has shown a steady decline in its incidence and related mortality over the past 20 years. The disparities in outcomes and overall survival (OS) between EO-CRC and AO-CRC are controversial. Our study compared OS and cause-specific survival (CSS) between metastatic EO-CRC (mEO-CRC) and metastatic AO-CRC (mAO-CRC) and identified the associated factors. Methods: Data on patient characteristics, tumor characteristics, incidence, and mortality were obtained from the SEER database from 2010 to 2020. We identified 23,278 individuals aged > 18 years with a confirmed diagnosis of all histological subtypes of metastatic CRC (M1 on TNM stage) using ICD-O-3 site codes. mEO-CRC and mAO-CRC were compared. OS distributions and CCS were analyzed using the Kaplan–Meier method and log-rank test to assess differences. A Cox regression model was used to assess the associations between variables. Results: mEO-CRC constituted 17.79% of the cases, whereas 82.21% had mAO-CRC. Most patients with mEO-CRC were 45–49 years old (47.66%), male (52.16%) and White (72.57%) and had adenocarcinoma histology (87.30%). Left colon tumors were most prevalent in both groups (40.26%) but were more prevalent in mEO-CRC patients than in mAO-CRC patients (49.63% vs. 38.23%,p< 0.001). Patients with mEO-CRC had higher OS (p< 0.001) and CSS (p< 0.001) than those with mAO-CRC. Patients with mEO-CRC also had significantly better median overall survival (30 months vs. 18 months,p< 0.001). The factors associated with worse OS included mAO-CRC (p< 0.001), mucinous adenocarcinoma (p< 0.001), male sex (p= 0.003), and a lack of surgical intervention (p< 0.001). Conclusions: Most patients with mEO-CRC fall within the range of 45 to 49 years of age. Patients with mEO-CRC were more likely to receive cancer-directed therapy (including chemotherapy and radiotherapy) and had better OS and CSS than those with mAO-CRC. This is likely attributable to the better performance status, fewer comorbidities, and better tolerance to cancer-directed therapy in mEO-CRC patients. The factors associated with worse OS and CSS were age > 50 years, mucinous adenocarcinoma, male sex, and no surgical treatment.
背景：早发性结直肠癌（EO-CRC）指50岁前确诊的结直肠癌，其发病率在过去十年持续上升，目前已占所有新发CRC病例的10%。而晚发性结直肠癌（AO-CRC）的发病率及相关死亡率在过去20年间呈稳定下降趋势。关于EO-CRC与AO-CRC在预后及总生存期（OS）方面的差异尚存争议。本研究比较了转移性早发性结直肠癌（mEO-CRC）与转移性晚发性结直肠癌（mAO-CRC）的总生存期及病因特异性生存期（CSS），并识别了相关影响因素。 方法：从SEER数据库中提取2010年至2020年患者特征、肿瘤特征、发病率及死亡率数据。通过ICD-O-3部位编码，共纳入23,278例年龄＞18岁、经病理确诊为转移性结直肠癌（TNM分期M1期）所有组织学亚型的患者。比较mEO-CRC与mAO-CRC两组人群，采用Kaplan-Meier法及对数秩检验分析OS分布与CSS差异，并运用Cox回归模型评估变量间的关联性。 结果：mEO-CRC占病例总数的17.79%，mAO-CRC占82.21%。mEO-CRC患者中多数年龄为45-49岁（47.66%）、男性（52.16%）、白人（72.57%），组织学类型以腺癌为主（87.30%）。左半结肠肿瘤在两组中均为最常见部位（40.26%），但在mEO-CRC患者中占比显著高于mAO-CRC患者（49.63% vs. 38.23%，p<0.001）。mEO-CRC患者较mAO-CRC患者具有更高的OS（p<0.001）与CSS（p<0.001），其中位总生存期显著更优（30个月 vs. 18个月，p<0.001）。与较差OS相关的因素包括：mAO-CRC（p<0.001）、黏液腺癌（p<0.001）、男性（p=0.003）以及未接受手术治疗（p<0.001）。 结论：多数mEO-CRC患者年龄集中于45-49岁。与mAO-CRC患者相比，mEO-CRC患者更可能接受癌症导向治疗（包括化疗与放疗），且具有更优的OS与CSS。这可能归因于mEO-CRC患者更好的体能状态、更少的合并症及对癌症导向治疗更强的耐受性。年龄＞50岁、黏液腺癌、男性及未接受手术治疗是与较差OS及CSS相关的影响因素。
肿瘤(癌症)患者之家