青年与老年结直肠癌临床病理特征的对比分析

目的 探讨青年与老年结直肠癌的临床病理特征及其与预后的关系.方法 回顾性分析1993年7月至2003年7月收治的68例35岁以下青年结直肠癌患者与322例65岁以上老年患者的临床资料,比较分析其临床表现、病理特征、肿瘤分期、误诊比例和随访结果.结果 青年组患者以腹痛为主,占69.1%(47/68);而老年组则以便血或黏液血便为主,占53.7%(173/322).青年组的肿瘤低分化比例为48.5%,明显高于老年组的20.5%(P＜0.01).青年组的肿瘤中晚期(Dukes分期C期 D期)比例为80.9%,明显高于老年组的50.3%(P＜0.01).青年组和老年组的误诊率分别为64.7%和14.O%,差异非常显著(P＜0.01).青年组3年生存率33.9%,明显低于老年组的67.3%(P＜0.01);其中肿瘤低分化患者的3年生存率在青年组和老年组分别为15.6%和43.4%,组间差异显著(P＜0.05);中晚期患者的3年生存率在青年组和老年组分别为25.0%和51.2%,差异非常显著(P＜0.01).结论 与老年患者相比,青年结直肠癌分化更差,侵袭性更强,且易贻误诊断,预后不良.因此,应充分加强青年结直肠癌的早期诊断.

Comparative study on clinical pathological characteristics of young and old patients with colorectal cancer

Objective To compare the clinical pathological characteristics in young and old patients with colorectal cancer (CRC) and investigate their relationship with prognosis. Methods A retrospective review was made in 68 CRC patients less than 35 years old and 322 CRC patients older than 65 treated in our hospital from July 1993 to July 2003. Their clinical manifestation, pathological feature, Dukes staging, misdiagnosis rate and results of following-up were compared. Results The main manifestation in young group was abdominal pain (69.1%), but in old group was hemafecia or mucous bloody stools (53.7%). The ratio of poorly differentiated neoplasm was obviously higher in young group (48.5%) than in old group (20.5%) (P<0.01). The ratio of Dukes C and D stage in young group (80.9%) was remarkably higher than in old group (50.3%) (P<0.01). The misdiagnosis rate was markedly higher in young group (64.7%) than in old group (14.0%)(P<0.01). The 3-year survival rate was higher in old group (67.3%) than that in young group (33.9%) (P<0.01), and the 3-year survival rate of patients with poorly differentiated tumor (15.6%) or of Dukes C and D stage (25.0%) was obviously lower in young group than that in old group (43.4%, 51.2%). Conclusion Compared with old group, young group is mainly of intermediate or advanced stage and has a higher misdiagnosis rate and poorer prognosis. Therefore, the early diagnosis of CRC in patients less than 35 years old should be enforced.