Background: Early onset colorectal cancer (EoCRC), diagnosed in those <50 years old, is increasing in incidence. We sought to differentiate characteristics and outcomes of EoCRC in patients with sporadic disease or preexisting conditions. Methods: We evaluated 2,135 patients with EoCRC in a population-based cohort from the Canadian province of British Columbia. Patients were identified on the basis of presence of hereditary syndromes ( n = 146) or inflammatory bowel disease (IBD; n = 87) and compared with patients with sporadic EoCRC ( n = 1,902). Results: Proportions of patients with preexisting conditions were highest in the youngest decile of 18–29 (34.3%, P < 0.0001). Patients with sporadic EoCRC were older, more likely female, and had increased BMI ( P < 0.05). IBD-related EoCRC had the highest rates of metastatic disease, poor differentiation, adverse histology, lymphovascular, and perineural invasion ( P < 0.05). Survival was lower in patients with IBD (HR, 1.80; 95% CI, 1.54–3.13; P < 0.0001) and higher in hereditary EoCRC (HR, 0.47; 95% CI, 0.45–0.73; P < 0.0001) compared with sporadic. Prognosis did not differ between ulcerative colitis or Crohn's disease but was lower in those with undifferentiated-IBD (HR, 1.87; 95% CI, 1.01–4.05; P = 0.049). Lynch syndrome EoCRC had improved survival over familial adenomatous polyposis (HR, 0.31; 95% CI, 0.054–0.57; P = 0.0037) and other syndromes (HR, 0.43; 95% CI, 0.11–0.99; P = 0.049). In multivariate analysis controlling for prognostic factors, hereditary EoCRC was unchanged from sporadic; however, IBD-related EoCRC had worse overall survival (HR, 2.21; 95% CI, 1.55–3.16; P < 0.0001). Conclusions: EoCRC is heterogenous and patients with preexisting conditions have different characteristics and outcomes compared with sporadic disease. Impact: Prognostic differences identified here for young patients with colorectal cancer and predisposing conditions may help facilitate treatment planning and patient counseling. See related commentary by Hayes, [p. 1775][1] This article is featured in Highlights of This Issue, [p. 1767][2] [1]: /lookup/volpage/30/1775?iss=10 [2]: /lookup/volpage/30/1767?iss=10

中文翻译：

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与散发性疾病相比，遗传性和炎症性肠病相关的早发性结直肠癌具有独特的特点和临床病程

背景：早发性结直肠癌 (EoCRC) 在年龄小于 50 岁的人群中被诊断出来，其发病率正在增加。我们试图区分散发性疾病或既往疾病患者的 EoCRC 特征和结果。方法：我们评估了来自加拿大不列颠哥伦比亚省的基于人群的队列中的 2,135 名 EoCRC 患者。根据是否存在遗传综合征（n = 146）或炎症性肠病（IBD；n = 87）来确定患者，并与散发性 EoCRC 患者（n = 1,902）进行比较。结果：在 18-29 岁最年轻的十分位中，有既往疾病的患者比例最高（34.3%，P < 0.0001）。散发性 EoCRC 患者年龄较大，多为女性，BMI 升高（P < 0.05）。IBD 相关的 EoCRC 的转移性疾病发生率最高，分化差、组织学不良、淋巴血管和神经周围侵犯（ P < 0.05）。与散发性相比，IBD 患者的存活率较低（HR，1.80；95% CI，1.54-3.13；P < 0.0001），而遗传性 EoCRC 患者的存活率较高（HR，0.47；95% CI，0.45-0.73；P < 0.0001）。溃疡性结肠炎或克罗恩病的预后没有差异，但未分化 IBD 患者的预后较低（HR，1.87；95% CI，1.01-4.05；P = 0.049）。与家族性腺瘤性息肉病（HR，0.31；95% CI，0.054-0.57；P = 0.0037）和其他综合征（HR，0.43；95% CI，0.11-0.99；P = 0.049）相比，Lynch 综合征 EoCRC 的生存率有所提高。在控制预后因素的多变量分析中，遗传性 EoCRC 与散发性相比没有变化；然而，IBD 相关的 EoCRC 的总生存期较差（HR，2.21；95% CI，1.55-3.16；P < 0.0001）。结论：EoCRC 具有异质性，与散发性疾病相比，具有既往疾病的患者具有不同的特征和结果。影响：此处确定的年轻结直肠癌患者和易感疾病的预后差异可能有助于促进治疗计划和患者咨询。见海斯的相关评论，[p. 1775][1] 这篇文章被收录在本期的亮点中，[p. 1767][2] [1]:/lookup/volpage/30/1775?iss=10 [2]:/lookup/volpage/30/1767?iss=10 1775][1] 这篇文章被收录在本期的亮点中，[p. 1767][2] [1]:/lookup/volpage/30/1775?iss=10 [2]:/lookup/volpage/30/1767?iss=10 1775][1] 这篇文章被收录在本期的亮点中，[p. 1767][2] [1]:/lookup/volpage/30/1775?iss=10 [2]:/lookup/volpage/30/1767?iss=10