AP&T:早发性结直肠癌的临床病理特征分析

2021-11-15 MedSci原创 MedSci原创

结肠癌有可能会导致排便不畅,但是排便不畅并不一定就是结肠癌。早期可以没有任何症状,中晚期可表现为腹胀、消化不良,而后出现排便习惯改变。

       由于美国和欧洲对CRC治疗的筛查和改进,50岁以上成年人的结直肠癌 (CRC) 发病率和死亡率正在下降。相反,年轻成人的CRC发病率,即早发性CRC (EOCRC),在世界一些地区正在上升。众所周知,患有林奇综合征 (LS) 或家族性腺瘤性息肉病 (FAP) 的个体在相对年轻的时候更容易患上CRC。大多数 EOCRC 是散发病例,导致年轻成人散发性 CRC 发病率增加的潜在因素仍不完全清楚,但似乎包括肥胖、缺乏体育锻炼、饮酒和吸烟等。此外,据报道有几种药物与 CRC 风险有关。口服抗生素的使用与 CRC 风险增加有关,而他汀类药物和阿司匹林的使用可能会降低这种风险。早发性结直肠癌 (EOCRC) 发病率的上升可能反映了一种新的肿瘤实体。因此,本项研究旨在探究散发性 EOCRC(<50岁患者)的临床病理特征。

 

       研究人员为了本项研究纳入了1989年至2016年间所有散发性EOCRC 患者,并按年龄划分:20-29 岁(I 组)、30-39 岁(II 组)和 40-49 岁(III 组)。然后对所有患者进行了统计学分析。

 

      最后本项研究共纳入了6400名患者。印戒细胞的存在和更多分化较差的肿瘤在较年轻的年龄组中更为常见:I 组和 II 组印戒细胞分别为 5.4% 和 3.7%,而 III 组为 1.4%(P<0.01)和 28.5低分化组 I 和 II 的 % 和 20.3% vs 组 III 的 16.6%(P<0.01 I 组;P=0.07 II 组)。在较年轻的年龄组中更频繁地观察到阳性淋巴结:I 组 16.2% vs II 组 9.3% ( P=0.01) 和 III 组7.9% ( P< 0.01)。随着时间的推移,在I组的女性中诊断出更大比例的 CRC(34.5% < 2004 vs 54.9%>2005,P=0.09),并且在年龄组 III 中发现更高比例的直肠癌(34.3% < 2004 年 VS 40.7% > 2005 年,P< 0.01)。平均总生存期为 6.3 年,并随着时间的推移而改善。

 

      本项研究证实EOCRC 的特征不仅在于发病年龄,还在于印戒细胞的出现频率更高、肿瘤分化程度更低、淋巴结转移风险更高。同时研究还发现近年来,30岁以下的直肠癌发病率较高,30岁以下的女性CRC发病率较高。

 

 

 

原始出处:

Fanny E. R. Vuik. Et al. Clinicopathological characteristics of early onset colorectal cancer. Alimentary Pharmacology & Therapeutics.2021.

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    2021-11-16 查查佳佳

    通气患者的一个重要问题,其危险因

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