Prognosis of Colorectal Cancer in Patients Younger Than 40 Years Old

四十歲以下患者罹患大腸直腸癌之預後：高雄榮民總醫院十三年之臨床經驗

歐文傑(Wen-Chieh Ou) ； 金台明(Tai-Ming King) ； 王瑞和(Jui-Ho Wang) ； 陳興保(Hsin-Pao Chen)

《中華民國大腸直腸外科醫學會雜誌》 16卷4期 (2005/12) Pp. 127-134

https://doi.org/10.6312/SCRSTW.2005.16(4).09418

摘要

目的　雖然大腸直腸癌好發於老年人，但一部份也確實發生於年輕患者。其發生率約為2.1至3.2%。 對於年輕人罹患大腸直腸癌的臨床表現及預後目前仍有爭議。因此我們針對四十歲以下罹患大腸直腸癌患者作回朔性的探討與分析。
方法　我們統計高雄榮總從1990年11月至2004年6月期間，四十歲以下罹患大腸直腸癌患者計有97位納入研究。我們針對這些患者的症狀表現、腫瘤分期、腫瘤細胞分化、腫瘤細胞型態及存活預後作回朔性的探討與分析。
結果　1990年11月至2004年6月期間有2,262大腸直腸癌病人，其中四十歲以下患者佔5.2%。48位男性及49位女性。平均年齡為33.1歲，而最年輕的患者是12歲。最常見的症狀表現為血便，大便習慣改變及腹痛。癌症第一期佔所有患者5.2%，第二期佔18.6%，第三期佔29.9%，及第四期佔46.4%。以腫瘤分期來說，五年存活率依序為第一期100%，第二期79.1%，第三期39.1%及第四期0%。戒指細胞型態、分化較差的細胞及顯微鏡下腫瘤血管侵犯皆為較不好的預後因子。
結論　年輕人罹患大腸直腸癌雖然多數被發現時已為癌症晚期。但以腫瘤期別來說，和老年人口比較並無較差之預後。而不好的細胞型態、分化較差的細胞及顯微鏡下腫瘤血管侵犯似乎沒有較高的發生率，但皆為較不好的預後因子。臨床上處理年輕患者或老年患者並無不同。兩者症狀表現上沒有太大差異，所以在診斷罹患大腸直腸癌之年輕患者必須高度警覺以便早期診斷。

關鍵字

大腸直腸癌 ； 年輕人

並列摘要

Purpose. Although colorectal cancer occurs in older patients predominantly, it also affects young adults with an incidence varying between 2.1 and 3.2 percent. However, it is still controversial regarding the features and prognosis of colorectal cancer in young patients. This is a retrospective analysis of colorectal cancer in patients younger than 40 years old.
Methods. Ninety-seven colorectal cancer patients with age under 40 years managed at Kaohsiung Veterans General Hospital between November 1990 to June 2004 were reviewed retrospectively. Symptoms, stages, tumor grade, histologic type and survival were studied.
Results. Patients under the age of 40 years with colorectal cancer represented 5.2 per cent (n=97) of the 2,262 patients between Nov. 1990 and Jun. 2004. Forty-eight (49.5%) patients were male and forty-nine (50.5%) were female. The mean age was 33.1 years, with the youngest patient being 12 years of age. Rectal bleeding, change in bowel habits and abdominal pain were the most common symptoms. 5.2% were stage Ⅰ, 18.6% stage Ⅱ, 29.9% stage Ⅲ and 46.4% stage Ⅳ respectively. The overall 5-year survival rate of all patients was 29.8%. The 5-year survival rates for stage 1 to stage 4 were 100%, 79.1%, 39.1%, and 0%. Signet-ring cell tumor (p＜0.000), poorly differentiated histology (p=0.017) and vascular invasion (p=0.031) were poor prognostic indicators in young patients.
Conclusions. Colorectal cancer in young patients appear to be more advanced in stage at presentation but have similar stage-related survival compared to published data of the general population. In our study, it seemed that there was no significantly higher incidence of unfavorable histologic type, poorly tumor grading and vascular invasion in comparison with literatures reported, but they were poor prognostic factors in young adults. The clinical management for young patients should be no difference from those for the old patients. The detection of colorectal cancer in young patients should be more alert because symptomatic presentation is not obviously different in two groups.

並列關鍵字

Colorectal cancer ； Young