PO.PS01.05 · 人群科学
直肠癌和乙状结肠癌推动美国早发性结直肠癌发病率上升
Rectal and sigmoid colon cancers drive rising early-onset colorectal cancer incidence in the United States
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
背景：50岁以下人群诊断的早发性结直肠癌（EOCRC）在美国的发病率不断上升，但原因尚不清楚。我们研究了美国EOCRC发病率和生存的近期趋势。
方法：使用美国国立癌症研究所监测、流行病学和最终结果项目（SEER 21）的去识别化数据，通过SEER*Stat按人口学和临床病理特征（包括年龄、性别、种族、肿瘤部位、分期、组织学以及县级的城乡程度、年度家庭收入、贫困和教育程度指标）评估2013-2022年（不含2020年）美国诊断的结直肠癌（CRC）病例。使用Joinpoint计算平均年度百分比变化。使用从癌症诊断到死亡或末次接触的时间计算年龄标准化的5年相对生存率和疾病特异性生存率。
结果：2013-2022年间总体CRC发病率下降，结肠癌和直肠乙状结肠交界处癌的下降比直肠癌更为明显。在50岁及以上人群中，除直肠外所有亚部位的发病率均显著下降。在50岁以下人群中，结肠癌和直肠癌分别以每年2.50%和4.15%的幅度显著上升。直肠癌在EOCRC中年度增幅最高，其次是乙状结肠（3.86%，p=0.002）、脾曲（2.97%，p=0.048）、重叠病变/非特指（NOS）结肠（1.79%，p=0.01）、横结肠（1.38%，p<0.001）和升结肠（1.08%，p<0.001）。在所有性别、种族/族裔、分期以及县级城乡、收入、贫困和教育程度组别中均观察到EOCRC的上升，都市县与非都市县相比年度增幅显著更高（3.05% vs. 1.78%，p<0.001）。腺癌（NOS）和神经内分泌肿瘤（NET）是早发性结肠癌（3.05%和1.50%）和直肠癌（4.15%和7.42%）上升的原因。以下人群生存较低：50岁及以上者；男性（相比女性）；黑人（相比白人）；区域期和远处期（相比局限期）；单身者（相比已婚者）；以及非都市、较低收入和教育程度、较高贫困的县。与腺癌（NOS）相比，黏液腺癌的生存显著较低，而NET和血液系统肿瘤的生存较高。
结论：近期EOCRC发病率的上升由直肠癌和乙状结肠癌发病率的上升所驱动，二者增幅最陡峭，在所有人口学和社会经济组别中同等出现，且与其他解剖亚部位相比诊断年龄更小、分期更晚。这些发现凸显了阐明EOCRC上升背后生物学和环境机制的必要性，以为预防和干预工作提供依据。
查看英文原文 English abstract
Background: Early-onset colorectal cancers (EOCRCs) diagnosed in people younger than 50 are increasing in incidence in the U.S., though the causes are unclear. We studied recent trends in EOCRC incidence and survival in the U.S.
Methods: De-identified data from the National Cancer Institute Surveillance, Epidemiology, and End Results Program (SEER 21) was used to evaluate colorectal cancer (CRC) cases diagnosed in the U.S. in 2013-2022 (excluding 2020) by demographic and clinic-pathologic characteristics including age, sex, race, tumor site, stage, histology, and county-level measures of rurality, annual household income, poverty, and education using SEER*Stat. Average annual percent change was calculated using Joinpoint. Age-standardized 5-year relative and disease-specific survival rates were calculated using time from cancer diagnosis to death or last contact.
Results: Overall CRC incidence declined from 2013-2022 in a manner that was more pronounced for colon and rectosigmoid junction cancers than rectal cancers. Among individuals aged 50+, incidence significantly declined for all subsites except for the rectum. Among individuals younger than 50, colon and rectal cancers significantly increased 2.50% and 4.15% annually, respectively. Rectal cancers showed the highest annual increase among EOCRCs, followed by sigmoid colon (3.86%, p = 0.002), splenic flexure (2.97%, p = 0.048), overlapping lesion/not otherwise specified (NOS) colon (1.79%, p = 0.01), transverse colon (1.38%, p < 0.001), and ascending colon (1.08%, p < 0.001). Increases in EOCRCs were observed for all sex, race/ethnicity, stage, and county-level rurality, income, poverty, and education groups, with significantly higher annual increases for metropolitan compared with nonmetropolitan counties (3.05% vs. 1.78%, p < 0.001). Adenocarcinomas (NOS) and neuroendocrine tumors (NET) accounted for increases in both early-onset colon (3.05% and 1.50%) and rectal cancers (4.15% and 7.42%). Survival was lower for individuals aged 50+; males compared with females; Blacks compared with Whites; regional and distant stages compared with localized; single individuals compared with married; and nonmetropolitan, lower income and education, and higher poverty counties. Survival was significantly lower for mucinous adenocarcinomas and higher for NET and hematologic cancers compared with adenocarcinomas (NOS).
Conclusions: The recent increase in EOCRC incidence has been driven by increases in rectal and sigmoid colon cancer incidence, which showed the steepest growths and equally across all demographic and socioeconomic groups, and were diagnosed at younger ages and at more advanced stages compared with other anatomical subsites. These findings highlight the need to elucidate biological and environmental mechanisms underlying the rise in EOCRC to inform prevention and intervention efforts.
利益披露 Disclosure
M. O. Nagata, None..
S. K. Kuwada, None.