| Background:Colorectal cancer is one of the most common gastrointestinal malignancy,with high morbidity and mortality.Its prognosis is related to many factors,the current research about the influence on the prognosis of colorectal cancer remains more controversial.(1)Previous studies have found that in metastatic colorectal cancer,the prognosis of the right colon cancer is worse than that of the left colon cancer.This view is also presented in the NCCN guide in 2017.However,the effect of tumor site on prognosis of early colorectal cancer in TNM stage was always debated.Some people think that the prognosis of the early right colon cancer patients is better than that of the left colon cancer,and some people think that there is no difference between the two in the early patients.At present,few studies have compared the prognosis of left colon cancer and rectal cancer in different TNM stages.(2)It is always controversial whether young colorectal cancer has a worse prognosis.Young patients are more likely to have bad prognostic factors in the behavior of tumor biology.But previous studies have shown different outcomes in terms of overall prognosis.(3)Marital status has been confirmed to have a significant impact on the prognosis of cancer,but previous studies have identified only those who are married and unmarried,but not distinguish between divorced,separated and widowed people.(4)Race as a prognostic indicator,there are no studies on the prognosis of colorectal cancer by comparison between the yellow race and other races.Objective:This study aim to from the race(black,white,yellow,and native American),tumor site(right colon cancer,left colon cancer,and rectal cancer),marital status(married and unmarried,widowed,divorced and separated),age of disease(youth,middle age and old age),study its effect on the prognosis of colorectal adenocarcinoma.Methods:A total of 94,239 cases of colorectal adenocarcinoma were collected from SEER database in the United States from 2004 to 2009.The effects of race,tumor site of different TNM stage,marital status and age on prognosis of colorectal adenocarcinoma were discussed in the first half.Appropriate statistical methods were used to compare the differences in baseline characteristics between groups,such as chi-square test,Pearson linear correlation analysis,etc.Secondly,Kaplan-Meier was used to draw the survival curve,and log-rank or Breslow test to verify whether there was significant difference.The influence of variables on the mortality of colorectal adenocarcinoma was analyzed by using COX and other proportional regression models,and the proportion hypothesis of Schoenfeld residual chart was used.The regression analysis of variables includes: age,gender,race,marital status,tumor site,degree of differentiation,TNM stage,send the number of lymph nodes,tumor size,lymph node ratio.Finally,the effects of various variables on specific mortality of colorectal adenocarcinoma were analyzed with the Fine-Gray competitive risk model.In this model,death for other reasons is considered to be the competition risk.The probability of cancer-related death and the probability of competitive risk death are expressed by cumulative incidence function,with Gray test check whether there is statistically significant.Results:Cox multivariate analysis and the Fine-Gray competitive risk model showed that 10 variables included in the analysis were independent predictors of total mortality and specific mortality of colorectal adenocarcinoma.(1)Race: The number of patients with colorectal cancer in white people decreased with the years,and the number of patients with yellow and native North Americans increased with the years,and the black race colorectal cancer cases showed no obvious linear correlation trend over the year.The survival of colorectal adenocarcinoma of yellow race was the best,significantly better than that of white people(HR,0.82;95% CI,0.79 to 0.85;P < 0.001);And the black patient had the lowest prognosis,with statistically significant differences compared with the white people(HR,1.17;95% CI,1.13 to 1.20;P < 0.001).The risk of tumor-specific death in patients with colorectal adenocarcinoma of the yellow race was 14% lower than that of white people(HR,0.86;95% CI,0.83 to 0.90;P < 0.001);The cancer specific mortality risk of black men was 23% higher than that of white people(HR,1.23;95% CI,1.19 to 1.28;P < 0.001).(2)Tumor site: The survival of patients with left-half adenocarcinoma was better than that of the right half-colon adenocarcinoma(HR,0.89;95% CI,0.88 to 0.91;P < 0.001),this advantage exists not only in stage IV(HR,0.78;95%CI,0.75-0.81;P<0.001),but also in stage 0/I(HR,0.89;95%CI,0.82-0.94;P=0.018),stage II(HR,0.92;95%CI,0.89-0.98;P=0.001)and stage III(HR,0.85;95%CI,0.82-0.88;P<0.001).The survival of patients with rectal adenocarcinoma was better than that of the left half of adenocarcinoma in patients with stage IV(HR,0.90;95% CI,0.84 to 0.96;P=0.001),and there was no statistically significant difference between the two in the 0/I,II and III patients.The specific mortality rate of patients with left half colon adenocarcinoma was 9% lower than that in the right half of the adenocarcinoma(HR,0.91;95% CI,0.88 to 0.93;(P<0.001),and the rectal adenocarcinoma was 11% lower than that in the right half of the adenocarcinoma(HR,0.89;95% CI,0.83 to 0.92;P < 0.001).(3)Marital status: The survival of married patients with colorectal adenocarcinoma was the best,significantly better than the unmarried group(HR,1.35;95% CI,1.31 to 1.38;P<0.001)and divorced,separated and widowed group(HR,1.42;95% CI,1.39 to 1.45;P < 0.001).The risk of specific mortality with unmarried patients was 29% higher than that in the married group(HR,1.29;95% CI,1.25 to 1.34;P < 0.001),the divorced,separated and widowed groups was 30% higher than that of the married group(HR,1.30;95% CI,1.27 to 1.34;P < 0.001).(4)Age: In the diagnosis of colorectal cancer,young people have worse differentiation degree,tumor stage,infiltration degree,lymph node metastasis and distant metastasis,tumor diameter.the middle-aged and elderly group had better tumor biological characteristics,especially in the elderly group.The total survival prognosis of young patients with colorectal adenocarcinoma was better than that of middle-aged patients(HR,1.26;95% CI,1.20 to 1.32;P<0.001)and elderly patients(HR,3.01;95% CI,2.87 to 3.17;P < 0.001);The specific mortality of middle-aged patients with colorectal cancer was 15% lower than that of the younger patients(HR,0.85;95% CI,0.81 to 0.99;P < 0.001),but the elderly patients was 2.02 times that of the youth group(HR,2.02;95% CI,1.92 to 2.14;P < 0.001).Schoenfeld residuals test included 10 variables that were roughly satisfied in the equal proportion hypothesis,and their effects on mortality did not change over time.Conclusions:(1)In recent years,the incidence of colorectal cancer in the yellow race has increased year by year,but it has a better prognosis than that of black,white and native Americans.(2)The prognosis of the right colon cancer is worse than that of the left colon and rectal cancer.This difference is not limited to metastatic colorectal cancer,but also in early patients.The prognosis of rectal cancer was better than that of the left colon cancer in stage IV,and there was no significant difference between the two survival outcomes in patients with stage 0/I 、II and III.(3)The prognosis of unmarried colorectal cancer patients was worse than that of married patients,while SDW had the worst prognosis among the three.(4)Young people diagnosed with colorectal cancer tend to have poorer tumor biological characteristics.Tumor-specific mortality among young patients was higher than that of middle-aged patients,but lower than in older patients.However,other causes of mortality among young patients with colorectal cancer was among the lowest among the three.After correction of other confounding factors,the young patients with colorectal cancer showed a better overall survival prognosis. |
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