青年与中老年结直肠癌临床病理特征及预后对比的meta分析  

Meta analysis of comparison of clinicopathological features and prognosis of colorectal cancer between youth and middle aged and elderly people

作　　者：王安民 银明 王紫薇 何勇奇 蔡雨洲 曾玉剑[1] WANG Anmin;YIN Ming;WANG Ziwei;HE Yongqi;CAI Yuzhou;ZENG Yujian(Department of Gastrointestinal and Hernia Surgery,the First Affiliated Hospital of Kunming Medical University,Kunming,Yunnan 650032,China;Department of Pediatrics,Kunming Guandu District People’s Hospital,Kunming,Yunnan 650299,China)

机构地区：[1]昆明医科大学第一附属医院胃肠与疝外科,昆明650032 [2]昆明市官渡区人民医院儿科,昆明650299

出　　处：《重庆医学》2025年第2期489-495,共7页Chongqing Medical Journal

基　　金：云南省高层次人才培养支持计划“名医专项”(RLMY20200021)。

摘　　要：目的 系统评价青年与中老年结直肠癌(CRC)患者的临床特征、病理特征及预后的差异。方法 检索2024年6月前中英文数据库的相关文献,采用Stata18和RevMan5.3软件对相关结局指标进行异质性分析、敏感性分析及发表偏倚检验。结果 共纳入17项病例对照研究,共6 817例病理检查确诊为结直肠癌的患者,其中青年组1 939例,中老年组4 878例。meta分析结果显示:青年组有家族史比例(OR=3.09,95%CI:2.33~4.09)、误诊率(OR=4.40,95%CI:3.30~5.86)、低分化癌比例(OR=3.57,95%CI:2.73~4.67)、黏液腺癌和印戒细胞癌比例(OR=3.41,95%CI:2.79~4.18)、确诊时TNM分期为Ⅲ~Ⅳ期的比例(OR=1.71,95%CI:1.44~2.02)、淋巴结转移发生率(OR=1.92,95%CI:1.61~2.28)、远处转移发生率(OR=2.09,95%CI:1.53~2.86)均高于中老年组(均P<0.05);青年组确诊时癌胚抗原阳性率(OR=0.68,95%CI:0.57~0.80)、5年生存率(OR=0.24,95%CI:0.16~0.36)低于中老年组(均P<0.05);两组肿瘤直径大小(OR=1.32,95%CI:0.98~1.77)差异无统计学意义(P=0.07)。结论 相较于中老年结直肠癌,青年结直肠癌患者家族相关性更密切、更易发生误诊、肿瘤恶性程度更高、确诊时TNM分期相对偏晚;临床上对青年结直肠癌的高危人群可适当放宽其筛检的年龄限制。Objective To systematically evaluate the differences in clinicopathologic features and prognosis of colorectal cancer(CRC)between youth and middle-aged and elderly people.Methods The relevant literatures in Chinese and English databases before June 2024 were retrieved.The Stata 18 and RevMan5.3 softwares were used to perform the heterogeneity and sensitivity analyses as well as publication bias tests for the relevant outcome indicators.Results A total of 17 case-control studies were included,including a total of 6817 patients with pathologically diagnosed CRC,among them 1939 cases in the young group and 4878 cases in the middle-aged and elderly group.The results of meta analysis showed that the proportion of family history in the young adult group(OR=3.09,95%CI:2.33-4.09),misdiagnosis rate(OR=4.40,95%CI:3.30-5.86),proportion of poorly differentiated carcinomas(OR=3.57,95%CI:2.73-4.67),proportion of mucinous adenocarcinomas and imprinted cell carcinomas(OR=3.41,95%CI:2.79-4.18),and proportion of TNM stage at diagnosis(stageⅢ-Ⅳ,OR=1.71,95%CI:1.44-2.02),incidence rate of lymph node metastasis(OR=1.92,95%CI:1.61-2.28),incidence rate of distant metastasis(OR=2.09,95%CI:1.53-2.86)were higher than those in the middle-aged and elderly group(all P<0.05);the CEA-positive rate at diagnosis(OR=0.68,95%CI:0.57-0.80)and 5-year survival rate(OR=0.24,95%CI:0.16-0.36)in the young group were lower than those in the middle-aged and elderly group(all P<0.05).The difference in the tumor diameter size(OR=1.32,95%CI:0.98-1.77)between the two groups was not statistically significant(P=0.07).Conclusion Compared with middle-aged and elderly CRC,young patients with CRC has a closer familial correlation,may be more easily misdiagnosed clinically,its malignant degree would be higher,and the TNM stage in diagnosis is relatively late;in clinic the young population with CRC high risk could be appropriately relaxed in the age limit for screening.

关 键 词：结直肠癌 临床特征 病理特征 预后 青年 META分析 

分 类 号：R735.34[医药卫生—肿瘤]