Jama Network: The survival rate of young colorectal cancer patients is lower. What is the reason?
Among adults under the age of 50 in the United States, colorectal cancer (CRC) is the second most common cause of cancer and the third largest cancer death. Although there is no clear definition of early colorectal cancer, in the published documents, age is less than 50 years old. Part of the reason for using this standard is that in the past 20 years, the American Independent Expert Group made some suggestions to conduct CRC screening for people aged 50 in the past 20.
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Early CRC (that is, CRC diagnosed at the age of 50) has unique clinical, genetic, and apparent genetic characteristics. Therefore, among individuals over 50 years old, it may be related to the survival rate of diagnostic colon cancer. The reporting period of the survival of patients with early colorectal cancer and the survival of patients with elderly colorectal cancer is not consistent.
In addition, patients with early colorectal cancer are more likely to be diagnosed in advanced. Considering that the age of 50 years of age is wide, the survival rate of early colorectal cancer at different ages may have heterogeneity. Therefore, some research teams use the National Cancer Database (NCDB) to analyze to verify these assumptions. The results of the research have recently been published in Jama Network.
The patients who studied this queue were 0-90 years old. From January 1, 2004 to December 31, 2015, it was diagnosed with primary colorectal cancer. In this study, patients 51 to 55 were diagnosed as a reference group and defined as late colorectal cancer. Excluding patients aged 50, try to reduce the obvious screening and detection bias in the age of the age, and consider that the early performance of these patients is not proportional. All statistical analysis time is from January 4, 2020 to December 26, 2020. The total survival rate of Kaplan-Meier analysis and COX ratio risk regression was used.
The results of the study showed that of 769871 patients with colorectal cancer (377890 cases (49.1%) were women; 636,791 White (82.7%), 353,989 (46.0%), 102,168 (13.3%) diagnosed as an early large intestine. Cancer, 7,8812 (10.2%) diagnosed as late colorectal cancer. In an unrealistic analysis, compared with patients between 51 and 55, the 10 -year survival rate of patients with early sedential colorectal cancer Low.
However, after adjusting other factors related to mortality (the most significant is the staging), compared with patients aged 51 to 55, the risk of death of early colorectal cancer patients is lower. In the model that corrected, HR of patients with early colorectal cancer was 0.89. Among individuals 35 to 39 and phase I and II diagnosis, the survival advantages are the largest, while the survival advantage does not exist in individuals between 25 or smaller and III to stage IV diagnosis.
This study found that the increased mortality rate of younger CRC patients in an unsettled analysis increased, which was related to being diagnosed in the later stage of the disease. This also shows that if more young patients are screened so that their diseases can be discovered in the early stage, they may reduce their mortality.
The survival advantages related to early CRC should be explained cautious in young individuals, because this advantage is small, and there is heterogeneity with different age and stage. It is necessary to further study to understand the potential heterogeneity of different ages and staged survival among patients with early colorectal cancer.
参考文献：Cheng E， Blackburn HN， Ng K， et al. Analysis of Survival Among Adults With Early-Onset Colorectal Cancer in the National Cancer Database. JAMA Netw Open. 2021;4(6)：e2112539. doi：10.1001/jamanetworkopen .2021.12539
