Affiliation:
1. Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Jiao Tong University, Shanghai, People's Republic of China
2. Department of Gastrointestinal Surgery, Shanghai Jiao Tong University, Shanghai, People's Republic of China
3. Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
4. State Key Laboratory of Oncogenes and Related Genes at Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
Abstract
Abstract
Background
Superficial colorectal cancer (SCRC) is defined as colorectal cancer (CRC) confined to the mucosa or submucosa. Endoscopic resection (ER) is widely used to resect differentiated SCRC from patients without lymph node metastasis (LNM). However, it is unclear whether ER is suitable for use with patients with differentiated early-onset SCRC because early-onset CRC is more aggressive. Therefore, we aimed to investigate the association between age of CRC onset and LNM.
Materials and Methods
We retrieved data for patients with surgically resected differentiated-type SCRCs from the Surveillance, Epidemiology, and End Results (SEER) database. Rate of LNM was compared among patients aged 18–39, 40–49, 50–59, 60–69, and ≥70 years. The association between age and LNM was further examined using multivariate logistic regression.
Results
We retrieved 34,506 records of differentiated SCRCs from the SEER database, including 667 patients aged 18–39 years, 2,385 aged 40–49, 8,075 aged 50–59 years, 9,577 aged 60–69 years, and 13,802 aged ≥70 years. Rates of LNM were 15.74%, 14.13%, 10.67%, 8.07%, and 6.76% for patients aged 18–39, 40–49, 50–59, 60–69, and ≥70 years, respectively. We found an inverse correlation between age at diagnosis and risk of LNM from the univariate analysis (p < .001). Compared with patients aged 18–39, the odds ratios with 95% confidence interval (CI) for patients aged 40–49, 50–59, 60–69, and ≥70 years were 0.90 (0.71–1.15, p = .376), 0.69 (0.56–0.87, p = .001), 0.54 (0.43–0.68, p < .001), and 0.47 (0.38–0.60, p < .001), respectively.
Conclusion
In differentiated SCRCs, younger age at diagnosis was associated with higher risk of LNM.
Implications for Practice
Endoscopic resection (ER) is widely used to resect differentiated superficial colorectal cancer (SCRC) without lymph node metastasis (LNM). However, no study has ever investigated risk of LNM of early-onset SCRC compared with average onset SCRC to explore whether ER is suitable for early-onset SCRC. To the authors' knowledge, this population-based study is the first study to find inverse correlation between age at diagnosis and risk of LNM in differentiated SCRCs. This finding indicates that ER may not be suitable for young patients with differentiated SCRC. Because the 30-day operative mortality after surgery is higher but the risk of LNM is lower in older patients compared with younger patients, ER for differentiated SCRCs may be advantageous over surgery for older patients.
Funder
Shanghai Municipal Key Clinical Specialty
National Natural Science Foundation of China
Shanghai municipal education commission-Gaofeng clinical medicine grant support
Three-year action plan for Shin Kang of Shanghai
Publisher
Oxford University Press (OUP)