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Abstract：
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.
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.
摘要：
背景：早发性结直肠癌（EO-CRC）定义为在50岁之前诊断出的结直肠癌，在过去的十年里，它的发病率一直在增加，目前占所有新的CRC诊断的10%.在过去的20年中，平均起病结直肠癌（AO-CRC）的发病率和相关死亡率稳步下降。EO-CRC和AO-CRC在结局和总生存期（OS）方面的差异是有争议的。我们的研究比较了转移性EO-CRC（mEO-CRC）和转移性AO-CRC（mAO-CRC）之间的OS和原因特异性生存期（CSS），并确定了相关因素。
方法：患者特征数据，肿瘤特征，发病率,和死亡率从2010年至2020年的SEER数据库获得。我们使用ICD-O-3位点代码鉴定了23,278名年龄>18岁的个体，并确认了转移性CRC的所有组织学亚型（TNM期M1）。比较mEO-CRC和mAO-CRC。使用Kaplan-Meier方法和对数秩检验分析OS分布和CCS以评估差异。使用Cox回归模型来评估变量之间的关联。
结果：mEO-CRC占病例的17.79%，而有MAO-CRC的占82.21%。大多数mEO-CRC患者年龄为45-49岁（47.66%），男性（52.16％）和白人（72.57％），有腺癌组织学（87.30％）。左结肠肿瘤在两组中最普遍（40.26％），但在mEO-CRC患者中比在mAO-CRC患者中更普遍（49.63％vs.38.23%,p<0.001)。mEO-CRC患者的OS(p<0.001)和CSS(p<0.001)高于mAO-CRC患者。患有mEO-CRC的患者的中位总生存期也明显更好（30个月vs.18个月,p<0.001)。与OS较差相关的因素包括MAO-CRC(p<0.001)，黏液腺癌（p<0.001），男性（p=0.003），缺乏手术干预（p<0.001）。
结论：大多数mEO-CRC患者的年龄范围为45至49岁。与MAO-CRC患者相比，MEO-CRC患者更有可能接受癌症定向治疗（包括化疗和放疗），并且OS和CSS更好。这可能归因于更好的性能状态，减少合并症，mEO-CRC患者对癌症定向治疗的耐受性更好。与OS和CSS较差相关的因素是年龄>50岁，黏液腺癌,男性,也没有手术治疗.
方法：患者特征数据，肿瘤特征，发病率,和死亡率从2010年至2020年的SEER数据库获得。我们使用ICD-O-3位点代码鉴定了23,278名年龄>18岁的个体，并确认了转移性CRC的所有组织学亚型（TNM期M1）。比较mEO-CRC和mAO-CRC。使用Kaplan-Meier方法和对数秩检验分析OS分布和CCS以评估差异。使用Cox回归模型来评估变量之间的关联。
结果：mEO-CRC占病例的17.79%，而有MAO-CRC的占82.21%。大多数mEO-CRC患者年龄为45-49岁（47.66%），男性（52.16％）和白人（72.57％），有腺癌组织学（87.30％）。左结肠肿瘤在两组中最普遍（40.26％），但在mEO-CRC患者中比在mAO-CRC患者中更普遍（49.63％vs.38.23%,p<0.001)。mEO-CRC患者的OS(p<0.001)和CSS(p<0.001)高于mAO-CRC患者。患有mEO-CRC的患者的中位总生存期也明显更好（30个月vs.18个月,p<0.001)。与OS较差相关的因素包括MAO-CRC(p<0.001)，黏液腺癌（p<0.001），男性（p=0.003），缺乏手术干预（p<0.001）。
结论：大多数mEO-CRC患者的年龄范围为45至49岁。与MAO-CRC患者相比，MEO-CRC患者更有可能接受癌症定向治疗（包括化疗和放疗），并且OS和CSS更好。这可能归因于更好的性能状态，减少合并症，mEO-CRC患者对癌症定向治疗的耐受性更好。与OS和CSS较差相关的因素是年龄>50岁，黏液腺癌,男性,也没有手术治疗.
