| Objective:At present,the incidence of early-onset colon cancer is on the rise globally,and it has become a major burden for young people.Right-and left-sided colon cancers in the elderly population have been identified as two diseases,and their respective diagnosis and treatment methods have been extensively studied.However,whether there is a difference in survival and prognosis between right-and left-sided early-onset colon cancer is rarely explored,and understanding this issue may contribute to improve the diagnosis and treatment of early-onset colon cancer.This study explored the 5-year overall survival(OS)and cancer-specific survival(CSS)of early-onset colon cancer patients stratified by tumor location and stage,and further constructed and assessed prognostic models for OS and CSS.Methods:1.The demographic and clinicopathological data of stage Ⅰ-Ⅲ early-oneset colon cancer patients(20 to 49 years old)who were diagnosed with primary adenocarcinoma of the colon in the Surveillance,Epidemiology,and End Results(SEER)database between January 2010 and December 2015 were retrospectively collected and analyzed.2.Kaplan-Meier curves and log-rank test were used for survival analysis.X-tile software was used to identify optimal cutoff values for variables such as age.Propensity score matching(PSM)analysis was adopted to reduce confounding and bias in baseline data.Logistics regression analysis was used to test for the potential bias in the data before and after PSM analysis.Univariate and multivariate Cox regression analyses were applied to establish prognostic models.Receiver operating characteristic curve(ROC),the area under curve(AUC)and concordance index(C-index)were analyzed to evaluate the prognostic models.Results:1.A total of 3924 patients with early-onset colon cancer were collected in this study,including 1568 and 2356 cases in the right-and left-sided patients,respectively.Fifteen variables,such as age,sex and ethnicity,were included in the analysis.2.After PSM analysis,OS(HR:0.96,95%CI:0.76-1.20,p=0.712)and CSS(HR:0.92,95%CI:0.73-1.16,p=0.500)in overall patients with right-and left-sided early-onset colon cancer were not significantly different.Stage Ⅰ(OS:HR:3.13,95%CI:0.78-12.53,p=0.140;CSS:p=0.071)and stage Ⅲ(OS:HR:1.27,95%CI:0.98-1.65,p=0.076;CSS:HR:1.16,95%CI:0.89-1.51,p=0.267)patients with right-and left-sided colon cancer had similar survival outcomes.However,stage Ⅱ right-sided patients had superior OS(HR:0.57,95%CI:0.35-0.93,p=0.027)and CSS(HR:0.51,95%CI:0.31-0.84,p=0.010)compared with left-sided patients.3.The OS and CSS prognostic models of the overall patients were established,and their AUC values were 0.758 and 0.765,respectively;and their C-index values were 0.764 and 0.787,respectively;indicating that the above models had good predictive ability.Conclusions:1.After PSM analysis,there was no difference in survival outcomes between overall patients with right-and left-sided early-onset colon cancer.2.Survival outcomes of patients were inconsistent among subgroups stratified by tumor location and stage.Stage Ⅱ right-sided colon cancer patients had better survival outcomes than left-sided cases,whereas there was no difference in survival between stages Ⅰ and Ⅲright-and left-sided patients.3.Factors such as ethnicity,T stage,and the number of tumor deposit were independent risk factors for OS and CSS in patients with early-onset colon cancer. |
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