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[早期和晚期直肠癌之间的临床特征和预后的比较研究]

H P Hong¹, A Huang¹, J Y Shi¹

¹Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China.

Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery

|June 23, 2025

概括

早发性直肠癌 (EORC) 在晚期出现,并且比晚发性直肠癌 (LORC) 有较差的结果. 然而,早期诊断和及时治疗可以显著提高EORC患者的生存率.

科学领域:

在瘤学瘤学.
胃肠病学胃肠病学
临床研究临床研究

背景情况:

在年轻人群中,直肠癌的发病率正在增加,因此需要对早期发病的直肠癌 (EORC) 和晚期发病的直肠癌 (LORC) 进行调查.
了解临床特征和预后差异对于优化不同年龄组的治疗策略至关重要.
识别特定于EORC的不良预后因素可以指导早期干预并改善患者的治疗结果.

研究的目的:

为了比较早发性直肠癌 (EORC) 和晚发性直肠癌 (LORC) 之间的临床特征和预后.
确定影响EORC患者整体生存 (OS) 和无进展生存 (PFS) 的独立风险因素.
分析直肠癌患者年龄和临床结果之间的关系.

主要方法:

对904名经过彻底切除的直肠癌患者 (2017-2022) 的回顾性队列研究.
倾向性得分匹配 (PSM) 以1:2的比例在EORC (<50岁) 和LORC (≥50岁) 组之间平衡混因素.
多变量考克斯回归和受限立方线分析以确定风险因素和年龄结果关联.

主要成果:

在PSM之前,EORC患者的T4和M1疾病发病率较高,并且接受了更多的新辅助和辅助疗法.
最初,LORC患者的平均寿命和PFS较长,但在PSM后,这些差异变得无关紧要.
在EORC中,高癌胚抗原 (CEA) 水平 (≥5μg/L) 和围神经侵入是死亡率的独立预测因素;高CEA也预测了癌症进展.

结论:

早期发病的直肠癌 (EORC) 经常在晚期被诊断出来,并且与晚期发病的直肠癌 (LORC) 相比,预后较差.
对于EORC的关键不利因素包括CEA水平升高和围神经侵入,突出了风险分层的目标.
虽然年龄显示出与结果的U形关联,但PSM表明年龄相关的生存率在年轻人群中没有显著的差异,强调了阶段和治疗的重要性.

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