Table. Pathological Features and Molecular Profile of Early-Onset Colorectal Cancer Pathological features Molecular profile Poor differentiation Microsatellite stability Mucinous tumors More likely to exhibit LINE-1 hypomethylation and TP53 sequence variations Signet-ring morphology Less frequently harbor KRAS, BRAF V600E, and APC sequence variations Perineural/venous invasion Promoter methylation of CpG islands Abbreviations: APC, adenomatous polyposis coli; BRAF, B-Raf; KRAS, K-Ras; LINE-1, long interspersed nuclear elements; TP53, tumor protein 53.
Background The molecular profile of early-onset colonic cancer is undefined. This study evaluated clinicopathological features and oncological outcomes of young patients with colonic cancer according to microsatellite status. Methods Anonymized data from an international collaboration were analysed. Criteria for inclusion were patients younger than 50 years diagnosed with stage I–III colonic cancer that was surgically resected. Clinicopathological features, microsatellite status, and disease-specific outcomes were evaluated. Results A total of 650 patients fulfilled the criteria for inclusion. Microsatellite instability (MSI) was identified in 170 (26.2 per cent), whereas 480 had microsatellite-stable (MSS) tumours (relative risk of MSI 2.5 compared with older patients). MSI was associated with a family history of colorectal cancer and lesions in the proximal colon. The proportions with pathological node-positive disease (45.9 versus 45.6 per cent; P = 1.000) and tumour budding (20.3 versus 20.5 per cent; P = 1.000) were similar in the two groups. Patients with MSI tumours were more likely to have BRAF (22.5 versus 6.9 per cent; P < 0.001) and KRAS (40.0 versus 24.2 per cent; P = 0.006) mutations, and a hereditary cancer syndrome (30.0 versus 5.0 per cent; P < 0.001; relative risk 6). Five-year disease-free survival rates in the MSI group were 95.0, 92.0, and 80.0 per cent for patients with stage I, II, and III tumours, compared with 88.0, 88.0, and 65.0 per cent in the MSS group (P = 0.753, P = 0.487, and P = 0.105 respectively). Conclusion Patients with early-onset colonic cancer have a high risk of MSI and defined genetic conditions. Those with MSI tumours have more adverse pathology (budding, KRAS/BRAF mutations, and nodal metastases) than older patients with MSI cancers.
Introducción: El abordaje multidisciplinario (MDT) en centros de alto volumen es el estándar de oro para el tratamiento de pacientes con cáncer de recto (CR) . No hay datos poblacionales en Latinoamérica que reflejen el tratamiento de estos pacientes en la región.Objetivo: Realizar una encuesta incluyendo países de Latinoamérica, cubriendo distintos puntos críticos en el manejo de pacientes con cáncer de recto.Materiales y métodos: Durante Mayo/2022, cirujanos de países dentro de la región fueron invitados a completar una encuesta cubriendo 3 puntos sobre manejo de pacientes con CR: Volumen anual de pacientes atendidos y complejidad del centro, técnica quirúrgica, y disponibilidad de MDT y tipos de tratamiento oncológico utilizados. Los cirujanos participantes fueron categorizados según el número de pacientes con cáncer de recto atendidos en su institución (bajo -CBV-, mediano -CMV- y alto volumen -CAV-).Resultados: 385 respuestas a la encuesta fueron incluidas en el análisis incluyendo centros de 18 países de Latinoamérica: 100/210/75 de centros de bajo, medio y alto volumen, respectivamente. CMV y CAV tuvieron mayor incidencia de cirujanos especializados a cargo de los pacientes con CR. 67.79% de los centros tienen acceso a técnicas mini-invasivas, siendo esto más frecuente en CMV y CAV. La utilización de neoadyuvancia en tumores localmente avanzados fue de 93.51%, con adherencia a protocolos de Watch & Wait de 60.78%. CMV y CAV presentaron mayores índices de abordaje multidisciplinario de los pacientes. Por último, la adherencia a estrategias de terapia neoadyuvante total y radioterapia de curso corto es baja, con mayor prevalencia en CMV y CAV.Conclusiones: Esta encuesta es la primera en aportar información sobre el tratamiento de CR en distintos centros y países de Latinoamérica. Futuros estudios deberán analizar el impacto de las diferencias entre centros sobre el resultado del tratamiento.
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