Abstract：
OBJECTIVE: Early-onset colorectal cancer (EO-CRC), diagnosed before age 50, is rising in incidence worldwide. Although post-surgical colonoscopy surveillance strategies exist, appropriate intervals in EO-CRC remain elusive, as long-term surveillance outcomes remain scant. We sought to compare findings of surveillance colonoscopies of EO-CRC with patients with average onset colorectal cancer (AO-CRC) to help define surveillance outcomes in these groups.
METHODS: Single-institution retrospective chart review identified EO-CRC and AO-CRC patients with colonoscopy and no evidence of disease. Surveillance intervals and time to development of advanced neoplasia (CRC and advanced polyps [adenoma/sessile serrated]) were examined. For each group, 3 serial surveillance colonoscopies were evaluated. Statistical analyses were performed utilizing log-ranked Kaplan-Meier method and Cox proportional hazards.
RESULTS: A total of 1259 patients with CRC were identified, with 612 and 647 patients in the EO-CRC and AO-CRC groups, respectively. Compared with patients with AO-CRC, patients with EO-CRC had a 29% decreased risk of developing advanced neoplasia from time of initial surgery to first surveillance colonoscopy (hazard ratio, 0.71; 95% confidence interval, 0.52-1.0). Average follow-up time from surgical resection to first surveillance colonoscopy was 12.6 months for both cohorts. Overall surveillance findings differed between cohorts (P = .003), and patients with EO-CRC were found to have less advanced neoplasia compared with their counterparts with AO-CRC (12.4% vs 16.0%, respectively). Subsequent colonoscopies found that, while patients with EO-CRC returned for follow-up surveillance colonoscopy earlier than patients with AO-CRC, the EO-CRC cohort did not have more advanced neoplasia nor non-advanced adenomas.
CONCLUSIONS: Patients with EO-CRC do not have an increased risk of advanced neoplasia compared with patients with AO-CRC and therefore do not require more frequent colonoscopy surveillance than current guidelines recommend.
METHODS: Single-institution retrospective chart review identified EO-CRC and AO-CRC patients with colonoscopy and no evidence of disease. Surveillance intervals and time to development of advanced neoplasia (CRC and advanced polyps [adenoma/sessile serrated]) were examined. For each group, 3 serial surveillance colonoscopies were evaluated. Statistical analyses were performed utilizing log-ranked Kaplan-Meier method and Cox proportional hazards.
RESULTS: A total of 1259 patients with CRC were identified, with 612 and 647 patients in the EO-CRC and AO-CRC groups, respectively. Compared with patients with AO-CRC, patients with EO-CRC had a 29% decreased risk of developing advanced neoplasia from time of initial surgery to first surveillance colonoscopy (hazard ratio, 0.71; 95% confidence interval, 0.52-1.0). Average follow-up time from surgical resection to first surveillance colonoscopy was 12.6 months for both cohorts. Overall surveillance findings differed between cohorts (P = .003), and patients with EO-CRC were found to have less advanced neoplasia compared with their counterparts with AO-CRC (12.4% vs 16.0%, respectively). Subsequent colonoscopies found that, while patients with EO-CRC returned for follow-up surveillance colonoscopy earlier than patients with AO-CRC, the EO-CRC cohort did not have more advanced neoplasia nor non-advanced adenomas.
CONCLUSIONS: Patients with EO-CRC do not have an increased risk of advanced neoplasia compared with patients with AO-CRC and therefore do not require more frequent colonoscopy surveillance than current guidelines recommend.
摘要：
背景：早发性结直肠癌（EO-CRC），在50岁之前被诊断出，全球发病率正在上升。尽管存在术后结肠镜检查监测策略，EO-CRC中的适当间隔仍然难以捉摸，因为长期监测结果仍然很少。我们试图将EO-CRC的监测结肠镜检查结果与平均起病结直肠癌（AO-CRC）患者进行比较，以帮助确定这些组的监测结果。
方法：单机构回顾性分析确定EO-CRC和AO-CRC患者行结肠镜检查，无疾病证据。检查了晚期瘤形成（CRC和晚期息肉（腺瘤/无柄锯齿状））的监测间隔和发展时间。对于每个小组，评估了3次连续监测结肠镜检查.利用对数排序的Kaplan-Meier方法和Cox比例风险进行统计分析。
结果：共确定了1259例CRC患者，EO-CRC和AO-CRC组中有612和647名患者，分别。与AO-CRC患者相比，EO-CRC患者从初次手术到首次结肠镜检查发生晚期肿瘤的风险降低了29%(HR=0.71,95%CI0.52-1.0)。两组患者从手术切除到首次结肠镜检查的平均随访时间为12.6个月。总体监测结果在队列之间有所不同(p=0.003)，与AO-CRC相比，EO-CRC的晚期瘤形成较少（12.4％vs16.0％，分别)。随后的结肠镜检查发现，尽管EO-CRC患者比AO-CRC患者更早返回进行结肠镜检查。EO-CRC队列没有更晚期的瘤形成,也没有非晚期的腺瘤.
结论：EO-CRC患者与AO-CRC患者相比，晚期肿瘤形成的风险没有增加，因此不需要比目前指南推荐的更频繁的结肠镜检查。
方法：单机构回顾性分析确定EO-CRC和AO-CRC患者行结肠镜检查，无疾病证据。检查了晚期瘤形成（CRC和晚期息肉（腺瘤/无柄锯齿状））的监测间隔和发展时间。对于每个小组，评估了3次连续监测结肠镜检查.利用对数排序的Kaplan-Meier方法和Cox比例风险进行统计分析。
结果：共确定了1259例CRC患者，EO-CRC和AO-CRC组中有612和647名患者，分别。与AO-CRC患者相比，EO-CRC患者从初次手术到首次结肠镜检查发生晚期肿瘤的风险降低了29%(HR=0.71,95%CI0.52-1.0)。两组患者从手术切除到首次结肠镜检查的平均随访时间为12.6个月。总体监测结果在队列之间有所不同(p=0.003)，与AO-CRC相比，EO-CRC的晚期瘤形成较少（12.4％vs16.0％，分别)。随后的结肠镜检查发现，尽管EO-CRC患者比AO-CRC患者更早返回进行结肠镜检查。EO-CRC队列没有更晚期的瘤形成,也没有非晚期的腺瘤.
结论：EO-CRC患者与AO-CRC患者相比，晚期肿瘤形成的风险没有增加，因此不需要比目前指南推荐的更频繁的结肠镜检查。
