The age of colorectal patients may impact on long<b>-</b>term survival: a real-world study based on DACCA database_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZOU Yuheng ^1,2 , LIAO Weihao ^1,2 , LIU Ying ^1,2 , ZHAO Tianlang ^1,2 ,  WANG Xiaodong ¹ , LI Li ¹

1. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. West China School of Medicine in Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

WANG Xiaodong, Email: wangxiaodong@wchscu.cn

Keywords：

colorectal cancer; age; pathological TNM stage; database; overall survival; disease specific survival

DOI：

10.7507/1007-9424.202203066

Video：

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Objective To analyze the relationship between age and prognosis of colorectal patients in the database from colorectal cancer (DACCA). Methods The DACCA version selected for this data analysis was updated on January 5, 2022. The data items analyzed included age, sex, tumor site, tumor pathological nature, obstruction, pathological TNM (pTNM) stage, positive lymph node ratio, survival status and survival time. According to China’s age segmentation standard, the included data were grouped into younger group (<35 years old), middle-aged group (35–59 years old) and elderly group (>59 years old). Overall survival (OS) and disease specific survival (DFS) were analyzed in three age group, and OS and DSS in three age group were analyzed in pTNM stage stratification. Results Three thousand six hundred and twenty-five rows of data were obtained from DACCA database according to the screening conditions. The survival analysis results of different age groups show that: The middle-aged group had better OS compared with the elderly group at 1-year (97.4% vs. 96.0%, P=0.037), 3-year (90.9% vs. 88.0%, P=0.030) and 5-year (81.7% vs. 75.7%, P=0.002). Also, the middle-age group had better 5-year DSS (82.2% vs. 77.7%, P=0.020). There was no statistical difference in survival between the younger group and the elderly group (P>0.05). The survival analysis results of different age groups in each pTNM stage show that: ① The middle-aged group had better medium-term and long-term OS than the elderly group. In the pTNM Ⅰ stage, the 3- and 5-year OS in the middle-aged group were better than those in the elderly group (100% vs. 93.4%, P=0.004; 100% vs. 91.4%, P=0.005). In the pTNM Ⅱ stage, the 5- and 10-year OS in the middle-aged group were better than those in the elderly group (96.5% vs. 91.3%, P=0.018; 88.2% vs. 54.3%, P<0.001). In pTNM Ⅲ stage, 10-year OS in the middle-aged group was better than that in the elderly group (36.5% vs. 36.0%, P<0.001). In pTNM Ⅳ stage, the 5- and 10- year of OS in the middle-aged group were better than those in the elderly group (67.7% vs. 58.4%, P=0.016; 19.1% vs. 7.2%, P=0.049). ② The middle-aged group had better medium-term and long-term DSS than the elderly group. In the pTNM Ⅰ stage, the 3- and 5- year DSS in the middle-aged group wrer better compared to the elderly group (100% vs. 96.9%, P=0.047; 100% vs. 94.9%, P=0.049). In the pTNM Ⅱ stage, the 10-year DSS in the middle-aged group outperformed that in the elderly group (88.2% vs. 61.9%, P=0.002). In the pTNM Ⅳ stage, the 5- and 10-year DSS in the middle-aged group were better than the elderly group (68.3% vs. 59.1%, P=0.020; 20.9% vs. 7.7%, P=0.040). ③ Except pTNM I stage, there was no significant difference in survival of other pTNM stages between young group and old group (P>0.05). In the pTNM Ⅰ stage, 3- and 5- year OS were better in the younger group compared with the elderly group (100% vs. 93.4%, P=0.004; 100% vs. 91.4%, P=0.005), and better 3- and 5- year DSS in the younger group (100% vs. 96.9%, P=0.047; 100% vs. 94.9%, P=0.049). Conclusions The age of colorectal cancer patients may have an impact on long-term survival. Middle-aged patients have better prognosis compared with elderly patients, and the younger group patients have better prognosis in pTNM stage Ⅰ only.

Citation： ZOU Yuheng, LIAO Weihao, LIU Ying, ZHAO Tianlang, WANG Xiaodong, LI Li. The age of colorectal patients may impact on long-term survival: a real-world study based on DACCA database. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(6): 795-802. doi: 10.7507/1007-9424.202203066 Copy

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2.	Arnold M, Sierra MS, Laversanne M, et al. Global patterns and trends in colorectal cancer incidence and mortality. Gut, 2017, 66(4): 683-691.
3.	龔佳祺, 劉瑩, 曾渝, 等. 結直腸癌患者的就診年齡與術前腫瘤相關特征的關系: 基于DACCA的真實世界數據研究. 中國普外基礎與臨床雜志, 2022, 29(3): 362-370.
4.	汪曉東, 劉健博, 李立. 數據庫建設第五部分: 結直腸癌的腫瘤特征—模塊的設計(二). 中國普外基礎與臨床雜志, 2020, 27(4): 483-488.
5.	汪曉東, 劉健博, 李立. 數據庫建設第六部分: 結直腸癌分期的標簽與結構化. 中國普外基礎與臨床雜志, 2020, 27(7): 873-879.
6.	汪曉東, 朱佳怡, 李立. 數據庫建設第十一部分: 結直腸癌隨訪的標簽與結構化. 中國普外基礎與臨床雜志, 2021, 28(10): 1353-1359.
7.	Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin, 2018, 68(4): 250-281.
8.	Ladabaum U, Dominitz JA, Kahi C, et al. Strategies for Colorectal Cancer Screening. Gastroenterology, 2020, 158(2): 418-432.
9.	LI J. Digestive cancer incidence and mortality among young adults worldwide in 2020: A population-based study. World J Gastrointest Oncol, 2022, 14(1): 278-294.
10.	Zhao L, Bao F, Yan J, et al. Poor prognosis of young patients with colorectal cancer: a retrospective study. Int J Colorectal Dis, 2017, 32(8): 1147-1156.
11.	Liu XY, Kang B, Cheng YX, et al. The short-term and oncologic outcomes of younger vs older colorectal cancer patients undergoing primary surgery: a propensity score matching analysis. BMC Cancer, 2022, 22(1): 153. doi: 10.1186/s12885-022-09246-4.
12.	Wang L, Hirano Y, Heng G, et al. Better cancer-specific survival in younger patients with stage Ⅲ colorectal cancer: a propensity score matching study from Japan. Anticancer Res, 2020, 40(8): 4365-4372.
13.	Wong SW, Ling DY, Yeow RQ, et al. Clinicopathological patterns and survival outcomes of colorectal cancer among young adults in Malaysia: an institutional cohort study. Singapore Med J, 2021, 62(12): 636-641.
14.	Mcclelland PH, Liu T, Ozuner G. Early-onset colorectal cancer in patients under 50 years of age: demographics, disease characteristics, and survival. Clin Colorectal Cancer, 2021 Nov 27: S1533-0028(21)00123-7. doi: 10.1016/j.clcc.2021.11.003.
15.	McCleary NJ, Zhang S, Ma C, et al. Age and comorbidity association with survival outcomes in metastatic colorectal cancer: CALGB 80405 analysis. J Geriatr Oncol, 2022 Jan 29: S1879-4068(22)00007-8. doi: 10.1016/j.jgo.2022.01.006.
16.	Mauri G, Sartore-Bianchi A, Russo AG, et al. Early-onset colorectal cancer in young individuals. Mol Oncol, 2019, 13(2): 109-131.
17.	Shemesh-Bar L, Kundel Y, Idelevich E, et al. Colorectal cancer in young patients in Israel: a distinct clinicopathological entity? World J Surg, 2010, 34(11): 2701-2709.
18.	Zlobec I, Lugli A. Prognostic and predictive factors in colorectal cancer. Postgrad Med J, 2008, 84(994): 403-411.
19.	呂炘沂, 劉健博, 謝欣然, 等. 基于傾向評分匹配的患者依從性對結直腸癌新輔助治療療效的影響. 實用醫學雜志, 2020, 36(22): 3104-3109.
20.	Patel SG, May FP, Anderson JC, et al. Updates on age to start and stop colorectal cancer screening: recommendations from the U. S. multi-society task force on colorectal cancer. Am J Gastroenterol, 2022, 117(1): 57-69.
21.	Fu JF, Huang YQ, Yang J, et al. Clinical characteristics and prognosis of young patients with colorectal cancer in Eastern China. World J Gastroenterol, 2013, 19(44): 8078-8084.
22.	Ahnen DJ, Wade SW, Jones WF, et al. The increasing incidence of young-onset colorectal cancer: a call to action. Mayo Clin Proc, 2014, 89(2): 216-224.

1. Vuik FE, Nieuwenburg SA, Bardou M, et al. Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years. Gut, 2019, 68(10): 1820-1826.
2. Arnold M, Sierra MS, Laversanne M, et al. Global patterns and trends in colorectal cancer incidence and mortality. Gut, 2017, 66(4): 683-691.
3. 龔佳祺, 劉瑩, 曾渝, 等. 結直腸癌患者的就診年齡與術前腫瘤相關特征的關系: 基于DACCA的真實世界數據研究. 中國普外基礎與臨床雜志, 2022, 29(3): 362-370.
4. 汪曉東, 劉健博, 李立. 數據庫建設第五部分: 結直腸癌的腫瘤特征—模塊的設計(二). 中國普外基礎與臨床雜志, 2020, 27(4): 483-488.
5. 汪曉東, 劉健博, 李立. 數據庫建設第六部分: 結直腸癌分期的標簽與結構化. 中國普外基礎與臨床雜志, 2020, 27(7): 873-879.
6. 汪曉東, 朱佳怡, 李立. 數據庫建設第十一部分: 結直腸癌隨訪的標簽與結構化. 中國普外基礎與臨床雜志, 2021, 28(10): 1353-1359.
7. Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin, 2018, 68(4): 250-281.
8. Ladabaum U, Dominitz JA, Kahi C, et al. Strategies for Colorectal Cancer Screening. Gastroenterology, 2020, 158(2): 418-432.
9. LI J. Digestive cancer incidence and mortality among young adults worldwide in 2020: A population-based study. World J Gastrointest Oncol, 2022, 14(1): 278-294.
10. Zhao L, Bao F, Yan J, et al. Poor prognosis of young patients with colorectal cancer: a retrospective study. Int J Colorectal Dis, 2017, 32(8): 1147-1156.
11. Liu XY, Kang B, Cheng YX, et al. The short-term and oncologic outcomes of younger vs older colorectal cancer patients undergoing primary surgery: a propensity score matching analysis. BMC Cancer, 2022, 22(1): 153. doi: 10.1186/s12885-022-09246-4.
12. Wang L, Hirano Y, Heng G, et al. Better cancer-specific survival in younger patients with stage Ⅲ colorectal cancer: a propensity score matching study from Japan. Anticancer Res, 2020, 40(8): 4365-4372.
13. Wong SW, Ling DY, Yeow RQ, et al. Clinicopathological patterns and survival outcomes of colorectal cancer among young adults in Malaysia: an institutional cohort study. Singapore Med J, 2021, 62(12): 636-641.
14. Mcclelland PH, Liu T, Ozuner G. Early-onset colorectal cancer in patients under 50 years of age: demographics, disease characteristics, and survival. Clin Colorectal Cancer, 2021 Nov 27: S1533-0028(21)00123-7. doi: 10.1016/j.clcc.2021.11.003.
15. McCleary NJ, Zhang S, Ma C, et al. Age and comorbidity association with survival outcomes in metastatic colorectal cancer: CALGB 80405 analysis. J Geriatr Oncol, 2022 Jan 29: S1879-4068(22)00007-8. doi: 10.1016/j.jgo.2022.01.006.
16. Mauri G, Sartore-Bianchi A, Russo AG, et al. Early-onset colorectal cancer in young individuals. Mol Oncol, 2019, 13(2): 109-131.
17. Shemesh-Bar L, Kundel Y, Idelevich E, et al. Colorectal cancer in young patients in Israel: a distinct clinicopathological entity? World J Surg, 2010, 34(11): 2701-2709.
18. Zlobec I, Lugli A. Prognostic and predictive factors in colorectal cancer. Postgrad Med J, 2008, 84(994): 403-411.
19. 呂炘沂, 劉健博, 謝欣然, 等. 基于傾向評分匹配的患者依從性對結直腸癌新輔助治療療效的影響. 實用醫學雜志, 2020, 36(22): 3104-3109.
20. Patel SG, May FP, Anderson JC, et al. Updates on age to start and stop colorectal cancer screening: recommendations from the U. S. multi-society task force on colorectal cancer. Am J Gastroenterol, 2022, 117(1): 57-69.
21. Fu JF, Huang YQ, Yang J, et al. Clinical characteristics and prognosis of young patients with colorectal cancer in Eastern China. World J Gastroenterol, 2013, 19(44): 8078-8084.
22. Ahnen DJ, Wade SW, Jones WF, et al. The increasing incidence of young-onset colorectal cancer: a call to action. Mayo Clin Proc, 2014, 89(2): 216-224.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The age of colorectal patients may impact on long-term survival: a real-world study based on DACCA database

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