Background: While colorectal cancer (CRC) incidence and mortality have declined among patients aged ≥50 years (late-onset), rates are increasing in those aged <50 years (early-onset). Historically, non-Hispanic Whites (NHW) have had better 5-year survival compared with non-Hispanic Blacks (NHB), and rectal cancer has had better outcomes than colon cancer. Whether these disparities by race and tumor location are evident for both early-onset (EOCRC) and late-onset (LOCRC) CRC remains unclear.Methods: CRC cases diagnosed from 2011 to 2022 were identified from the Louisiana Tumor Registry. EOCRC was defined as diagnoses at ages 20–49 years, and LOCRC was defined as diagnoses at ages ≥50 years. Racial groups included NHW and NHB; tumor location was categorized as proximal colon, distal colon, or rectum. Cox regression was used to assess unadjusted and adjusted overall and cancer-specific survival.Results: Of 23,738 CRC patients, 10.7% were diagnosed at age <50 years. Compared to LOCRC, EOCRC patients included a higher proportion of NHB (37.5% vs. 32.6%) and rectal tumors (44.4% vs. 29.9%). NHB had worse overall survival than NHW in early-onset distal colon cancer (adjusted HR [aHR] = 1.358; 95%CI: 1.024–1.801). Conversely, NHB had better overall (aHR = 0.899; 95%CI: 0.831–0.973) and cancer-specific survival (aHR = 0.873; 95%CI: 0.793–0.960) in late-onset rectal cancer. Among EOCRC NHW, proximal tumors were associated with worse overall (aHR = 1.407; 95%CI: 1.102–1.796) and cancer-specific survival (aHR = 1.379; 95%CI: 1.057–1.799) compared with distal tumors.Conclusions:Survival differences by race and tumor subsite are observed between EOCRC and LOCRC, with NHB showing a lower hazard of death in some LOCRC subgroups. These findings highlight the need to consider the age of onset and tumor location when addressing racial disparities in CRC outcomes.
背景：尽管结直肠癌（CRC）在≥50岁患者（晚发性）中的发病率和死亡率有所下降，但在<50岁人群（早发性）中却呈上升趋势。从历史数据看，非西班牙裔白人（NHW）的5年生存率优于非西班牙裔黑人（NHB），且直肠癌的预后优于结肠癌。然而，这些基于种族和肿瘤部位的差异在早发性结直肠癌（EOCRC）与晚发性结直肠癌（LOCRC）中是否同样显著，目前尚不明确。 方法：从路易斯安那肿瘤登记处提取2011年至2022年确诊的CRC病例。EOCRC定义为20–49岁确诊，LOCRC定义为≥50岁确诊。种族分组包括NHW和NHB；肿瘤部位分为近端结肠、远端结肠或直肠。采用Cox回归模型评估未经调整及调整后的总生存期和癌症特异性生存期。 结果：在23,738例CRC患者中，10.7%在<50岁时确诊。与LOCRC相比，EOCRC患者中NHB比例更高（37.5% vs. 32.6%），直肠肿瘤比例也更高（44.4% vs. 29.9%）。在早发性远端结肠癌中，NHB的总生存期较NHW更差（调整后风险比[aHR] = 1.358；95%置信区间[CI]: 1.024–1.801）。相反，在晚发性直肠癌中，NHB的总生存期（aHR = 0.899；95%CI: 0.831–0.973）和癌症特异性生存期（aHR = 0.873；95%CI: 0.793–0.960）均优于NHW。在EOCRC的NHW患者中，与远端肿瘤相比，近端肿瘤的总生存期（aHR = 1.407；95%CI: 1.102–1.796）和癌症特异性生存期（aHR = 1.379；95%CI: 1.057–1.799）更差。 结论：EOCRC与LOCRC在种族和肿瘤亚部位上存在生存差异，其中NHB在某些LOCRC亚组中表现出更低的死亡风险。这些发现提示，在探讨CRC预后中的种族差异时，需综合考虑发病年龄和肿瘤部位的影响。
Effect of Race and Tumor Subsite on Survival Outcome in Early- and Late-Onset Colorectal Cancer
肿瘤(癌症)患者之家