Incidence trends and long-term survival in early-onset colorectal cancer: a nationwide Swedish study.

IF 65.4 1区医学 Q1 ONCOLOGY

Annals of Oncology Pub Date : 2025-08-13 DOI:10.1016/j.annonc.2025.07.019

S Barot, A Liljegren, C Nordenvall, J Blom, C Radkiewicz

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引用次数: 0

Abstract

Background: Early-onset colorectal cancer (EOCRC, diagnosis before age 50) is increasing globally. Survival comparisons with late-onset colorectal cancer (CRC) are inconsistent, however, and long-term excess mortality remains poorly understood. This Swedish population-based study aimed to evaluate trends in incidence, survival, and long-term excess mortality in early- versus late-onset CRC.

Materials and methods: We identified all incident colorectal adenocarcinomas recorded in the Swedish National Cancer Register from 1993 to 2019. Incidence trends were quantified using annual percentage changes and relative survival differences were assessed using excess mortality rate ratios, both from Poisson regression models with 95% confidence intervals (CIs).

Results: A total of 47 864 right-sided colon, 40 664 left-sided colon, and 47 082 rectal cancer cases were included. EOCRC patients were more frequently diagnosed with metastatic disease, compared with late-onset CRC. EOCRC incidence increased across all subsites, with annual percentage changes ranging from 2.04 (95% CI 1.51-2.56) for rectal to 2.64 (95% CI 2.02-2.37) for right-sided colon cancer, while an increase among late-onset cases was observed only for right-sided colon cancer. Crude 5-year relative survival was similar across age groups, but after full adjustment (including metastatic stage), EOCRC was associated with better survival, with excess mortality rate ratios ranging from 0.76 (95% CI 0.68-0.84) for rectal cancer to 0.83 (95% CI 0.74-0.92) for right-sided colon cancer. Notably, excess mortality remained elevated 5-10 years after diagnosis in both age groups.

Conclusions: EOCRC incidence is increasing in Sweden, aligning with global trends. Although younger patients were more often diagnosed at an advanced stage of disease, they had similar crude survival and better stage-adjusted survival, compared with older patients. The persistent long-term excess mortality in both groups, even during periods when CRC patients are typically considered statistically cured, highlights the need for extended follow-up and tailored survivorship care.

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早发性结直肠癌的发病率趋势和长期生存率：一项瑞典全国性研究。

背景：早发性结直肠癌（EOCRC， 50岁前诊断）在全球范围内呈上升趋势。然而，与晚发性结直肠癌（CRC）的生存比较不一致，长期超额死亡率仍然知之甚少。这项基于瑞典人群的研究旨在评估早发性和晚发性CRC的发病率、生存率和长期超额死亡率的趋势。材料和方法：我们确定了1993年至2019年瑞典国家癌症登记处记录的所有结直肠癌事件。发病率趋势用年百分比变化（APCs）量化，相对生存差异用超额死亡率比（EMRRs）评估，两者均来自95%置信区间（ci）的泊松回归模型。结果：共纳入右侧结肠癌47,864例，左侧结肠癌40,664例，直肠癌47,082例。与晚发性CRC相比，EOCRC患者更常被诊断为转移性疾病。EOCRC的发病率在所有亚位点都有所增加，直肠的APCs为2.04 (95% CI 1.51-2.56)，右侧结肠癌的APCs为2.64 (95% CI 2.02-2.37)，而晚发病例中只有右侧结肠癌的APCs增加。各年龄组的粗5年相对生存率相似，但在完全调整后（包括转移期），EOCRC与更好的生存率相关，直肠癌的EMRRs为0.76 (95% CI 0.68-0.84)，右侧结肠癌的EMRRs为0.83 （95% CI 0.74-0.92）。值得注意的是，在这两个年龄组中，诊断后5-10年的超额死亡率仍然很高。结论：瑞典的EOCRC发病率正在上升，与全球趋势一致。尽管年轻患者更常被诊断为疾病晚期，但与老年患者相比，他们的粗生存率相似，分期调整生存率更高。在两组患者中，即使在统计上认为结直肠癌患者通常已经治愈的时期，持续的长期过度道德也突出了延长随访和量身定制的生存护理的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Oncology 医学-肿瘤学

CiteScore

63.90

自引率

1.00%

发文量

3712

审稿时长

2-3 weeks

期刊介绍： Annals of Oncology, the official journal of the European Society for Medical Oncology and the Japanese Society of Medical Oncology, offers rapid and efficient peer-reviewed publications on innovative cancer treatments and translational research in oncology and precision medicine. The journal primarily focuses on areas such as systemic anticancer therapy, with a specific emphasis on molecular targeted agents and new immune therapies. We also welcome randomized trials, including negative results, as well as top-level guidelines. Additionally, we encourage submissions in emerging fields that are crucial to personalized medicine, such as molecular pathology, bioinformatics, modern statistics, and biotechnologies. Manuscripts related to radiotherapy, surgery, and pediatrics will be considered if they demonstrate a clear interaction with any of the aforementioned fields or if they present groundbreaking findings. Our international editorial board comprises renowned experts who are leaders in their respective fields. Through Annals of Oncology, we strive to provide the most effective communication on the dynamic and ever-evolving global oncology landscape.