PDF(Pubmed)
Abstract：
Background: The incidence of colorectal cancer (CRC) is decreasing in individuals >50 years due to organised screening but has increased for younger individuals. We characterized symptoms and their timing before diagnosis in young individuals. Methods: We identified all patients diagnosed with CRC between 1990-2017 in British Columbia, Canada. Individuals <50 years (n = 2544, EoCRC) and a matched cohort >50 (n = 2570, LoCRC) underwent chart review to identify CRC related symptoms at diagnosis and determine time from symptom onset to diagnosis. Results: Across all stages of CRC, EoCRC presented with significantly more symptoms than LoCRC (Stage 1 mean ± SD: 1.3 ± 0.9 vs. 0.7 ± 0.9, p = 0.0008; Stage 4: 3.3 ± 1.5 vs. 2.3 ± 1.7, p < 0.0001). Greater symptom burden at diagnosis was associated with worse survival in both EoCRC (p < 0.0001) and LoCRC (p < 0.0001). When controlling for cancer stage, both age (HR 0.87, 95% CI 0.8-1.0, p = 0.008) and increasing symptom number were independently associated with worse survival in multivariate models. Conclusions: Patients with EoCRC present with a greater number of symptoms of longer duration than LoCRC; however, time from patient reported symptom onset was not associated with worse outcomes.
摘要：
背景：由于有组织的筛查，结直肠癌（CRC）的发病率在50岁以上的个体中正在下降，但在年轻个体中却有所增加。我们在年轻个体中描述了症状及其诊断前的时机。方法：我们确定了不列颠哥伦比亚省1990年至2017年之间诊断为CRC的所有患者，加拿大。对<50岁的个体(n=2544,EoCRC)和匹配的队列>50(n=2570,LoCRC)进行图表审查,以在诊断时识别CRC相关症状并确定从症状发作到诊断的时间。结果：在CRC的所有阶段，EoCRC的症状明显多于LoCRC（1期平均值±SD：1.3±0.9vs.0.7±0.9，p=0.0008；阶段4：3.3±1.5vs.2.3±1.7，p<0.0001）。在EoCRC（p<0.0001）和LoCRC（p<0.0001）中，诊断时更大的症状负担与更差的生存率相关。当控制癌症分期时，在多变量模型中,年龄(HR0.87,95%CI0.8-1.0,p=0.008)和症状数量增加均与较差的生存率独立相关.结论：与LoCRC相比，EoCRC患者的症状持续时间更长；然而，患者报告的症状出现时间与不良结局无关.
