Mortality And Prognostic Factors Of Colorectal Cancer In Adolescents And Young Adults:A Retrospective Cohort Study Based On The Surveillance,Epidemiology And End Results(SEER) Database

Objective:Colorectal cancer(CRC)is the third most common malignant tumor in the world.There is a gap in the survival improvement rate between adolescents and middle-aged and elderly cancer patients.However,the specific mortality and prognostic factors of colorectal cancer in adolescents and young adults(AYAs)are rarely reported.This article aims to analyze the colorectal cancer mortality and specific mortality in AYAs,and compare the differences in prognostic factors between AYAs and middle-aged and elderly people(MAEP).Methods:A retrospective cohort study was conducted based on the Surveillance,Epidemiology,and End Results(SEER)database.Univariate and multivariate Cox proportional hazard models were used to investigate the factors affecting overall survival(OS).Fine-Gray test was used to construct a competitive risk model to investigate the factors affecting specific mortality.The results showed a hazard ratio(HR)of 95 % confidence interval(CI).Results:The MAEP group had a higher all-cause mortality(HR : 1.12,95 % CI : 1.18-1.28),but the CRC-specific mortality was lower than the AYAs group(HR : 0.917,95 % CI :0.88-0.95).Male(HR : 1.199,95 % CI : 1.182-1.217),appendix(HR : 1.076,95 % CI :1.046-1.108),colon hepatic flexure(HR : 1.085,95 % CI : 1.053-1.119),transverse colon(HR : 1.103,95 % CI : 1.055-1.152),colon spleen area(HR : 1.1,95 % CI : 1.062-1.139),operation range greater than 60 cm(HR : 1.146,95 % CI : 1.092-1.204),chemotherapy(HR : 1.552,95 % CI : 1.524-1.58)were the main risk factors for worse OS in MAEP patients.Asian or Pacific Islanders(HR : 1.121,95 % CI : 1.02-1.231),transverse colon(HR : 1.068,95 % CI : 1.011-1.127),surgical range > 60cm(HR : 1.132,95 % CI :1.107-1.197),chemotherapy(HR : 1.336,95 % CI : 1.307-1.365)were significantly associated with an increased risk of CSS deterioration in MAEP.The pathological type of squamous cell carcinoma was a risk factor for OS and CSS in AYAs(HR : 1.526,95 % CI :1.111-2.096 VS HR : 1.494,95 % CI : 1.068-2.091).Elevated CEA was not a risk factor for OS and CSS in both AYAs and MAEP.Conclusion:AYAs have a high risk of CRC-specific death,suggesting that AYAs with CRC should be further concerned.Tumor location,pathological type,surgical range,and chemotherapy are factors affecting the prognosis of OS and CSS.