目前美国早发性结直肠癌(EOCRC)的研究主要集中在白人,非洲裔美国人,和西班牙裔,但在亚洲人和美国的夏威夷原住民中,人们对EOCRC知之甚少。EOCRC在夏威夷的多民族人口中进行了检查。来自夏威夷肿瘤登记处的数据用于分析2000-2019年在夏威夷诊断的结直肠癌(CRC)病例,年龄,性别,种族,和舞台。种族分析仅限于3524例CRC病例,在2015-2019年之间诊断。5年平均年龄调整发病率和死亡率,随着时间的推移,平均每年百分比变化,并评估5年生存率。组比较采用卡方和二项比例检验。总体CRC发病率和死亡率下降,并且与直肠/直肠乙状结肠交界处癌相比,结肠更明显。对于45岁以下的病例,结肠癌发病率显着增加了1.46倍,对于45-54岁的病例,直肠/直肠乙状结肠癌显着增加了1.54倍。从2000-2009年到2010-2019年,45-54岁女性的CRC发病率急剧增加,45-54岁女性的结肠和直肠/直肠乙状结肠癌发病率增加。在两性中,55岁以下人群的直肠/直肠乙状结肠癌发病率的增加在I期癌症中最高.总的来说,与日本人相比,夏威夷原住民的CRC诊断平均年龄(SD)为5-10岁(60.6[13.3]岁),中文,菲律宾人,Whites,和其他亚洲人(p<0.001)。夏威夷原住民占55岁以下被诊断为CRC的更大比例,相反,与日本相比,55岁及以上的病例比例较小,中文,菲律宾人,Whites,和其他亚洲人。夏威夷原住民的CRC相关死亡率(14.5/100,000[95%CI:12.4,16.8])明显高于日本人(10.7/100,000[95%CI:9.3,12.3]),CRC存活率(62.2%[95%CI:59.1,65.2])明显低于日本人(71.9%[95%CI:69.9,73.8]),菲律宾人(71.9%[95%CI:69.2,74.4]),中国人(70.2%[95%CI:65.5,74.4]),白人(69.3%[95%CI:67.1,71.4]),和其他亚洲人(71.7%[95%CI:66.2,76.5])。在我们多样化的美国人口中,夏威夷原住民对EOCRC的贡献不成比例,比白人早5-10年,日本人,中文,菲律宾人。夏威夷女性的EOCRC增长速度快于男性,这与美国普通人口的趋势不同。在美国,EOCRC中出现的种族差异表明需要对EOCRC的针对性干预措施和种族特异性风险因素进行研究。
Current characteristics of early onset colorectal cancer (EOCRC) in the United States have been mainly studied in Whites, African Americans, and Hispanics, but little is known in regard to EOCRC in Asians and Native Hawaiians in the US. EOCRC was examined in Hawaii\'s multiethnic population. Data from the Hawaii Tumor Registry was used to analyze colorectal cancer (CRC) cases diagnosed in Hawaii from 2000-2019 by subsite, age, gender, ethnicity, and stage. Ethnicity analyses were limited to 3524 CRC cases, diagnosed between 2015-2019. Average annual 5-year age-adjusted incidence and mortality rates, average annual percent change over time, and 5-year survival were evaluated. Group comparisons utilized Chi-square and binomial proportion tests. Overall CRC incidence and mortality declined and were more pronounced for colon than rectal/rectosigmoid junction cancers. Colon cancer incidence rates significantly increased 1.46-fold for cases diagnosed under 45 years of age and rectal/rectosigmoid cancers significantly increased 1.54-fold for cases 45-54 years of age. CRC incidence increased sharply for females aged 45-54 years from 2000-2009 to 2010-2019, and increases in colon and rectal/rectosigmoid cancer among individuals aged 45-54 were higher for females. Among both sexes, the increase in rectal/rectosigmoid cancer incidence for individuals under 55 years was highest for stage I cancers. Overall, the mean (SD) age of CRC diagnosis was 5-10 years earlier for Native Hawaiians (60.6 [13.3] years) compared with Japanese, Chinese, Filipinos, Whites, and Other Asians (p < 0.001). Native Hawaiians constituted a greater proportion of CRC diagnosed under age 55 years and, conversely, a smaller proportion of cases 55 years and older compared with Japanese, Chinese, Filipinos, Whites, and Other Asians. Native Hawaiians had a significantly higher CRC-related mortality rate (14.5 per 100,000 [95% CI: 12.4, 16.8]) compared with Japanese (10.7 per 100,000 [95% CI: 9.3, 12.3]) and a significantly lower CRC survival rate (62.2% [95% CI: 59.1, 65.2]) compared with Japanese (71.9% [95% CI: 69.9, 73.8]), Filipinos (71.9% [95% CI: 69.2, 74.4]), Chinese (70.2% [95% CI: 65.5, 74.4]), Whites (69.3% [95% CI: 67.1, 71.4]), and Other Asians (71.7% [95% CI: 66.2, 76.5]). In our diverse US population, Native Hawaiians contribute disproportionately to EOCRC and present 5-10 years earlier than Whites, Japanese, Chinese, and Filipinos. EOCRCs are increasing faster in females than males in Hawaii, which differs from trends in the general US population. Emerging ethnic disparities in EOCRC in the US speak to the need for studies on targeted interventions and ethnic-specific risk factors for EOCRC.