ABSTRACT
ABSTRACT Background: Early-onset colorectal cancer (EO-CRC) incidence has increased significantly worldwide in recent years, and these individuals frequently have advanced disease at the time of diagnosis. This study examines the clinicopathological characteristics of EO-CRC cases diagnosed at an academic healthcare center in Spain. Methods: A retrospective record review study of patients diagnosed with EO-CRC from 2010 to 2021 was performed. Clinical and pathological data were collected. Results: A total of 101 patients were included. The majority of cases (75.3%) were diagnosed in the age group between 40 and 49 years, specifically within the subgroup of 46-49 years. A family history of colorectal cancer was found in 23% of patients. Left-sided tumors were more common (43.6%), and most patients were diagnosed at advanced stages (34.7% at stage III and 32.7% at stage IV). The majority of patients (94.1%) were symptomatic, with rectal bleeding being the most prevalent clinical presentation. The most frequent histological type was moderately differentiated adenocarcinoma (44.6%). KRAS mutant tumors were found in 18.8% and BRAF mutant tumors in 11.9%. 67.3% had microsatellite stability. Tumor recurrence occurred in 24.8% of the patients, while 27.7% of the patients died. Conclusion: From 2010 to 2021, EO-CRC accounted for 3% of all colorectal cancer cases. To improve early diagnosis and treatment, physicians should maintain a high suspicion of red flag symptoms in young patients. To decrease EO-CRC morbidity and mortality, starting diagnostic screening tests at age 45 should be considered.
RESUMO Contexto: A incidência de câncer colorretal de início precoce (CCR-IP) tem aumentado significativamente em todo o mundo nos últimos anos, e esses indivíduos frequentemente apresentam doença avançada no momento do diagnóstico. Este estudo examina as características clinicopatológicas dos casos de CCR-IP diagnosticados em um centro de saúde acadêmico na Espanha. Métodos: Realizado um estudo retrospectivo de revisão de prontuários de pacientes diagnosticados com CCR-IP de 2010 a 2021. Dados clínicos e patológicos foram coletados. Resultados: Foram incluídos um total de 101 pacientes. A maioria dos casos (75,3%) foi diagnosticada na faixa etária entre 40 e 49 anos, especificamente dentro do subgrupo de 46 a 49 anos. Histórico familiar de câncer colorretal foi encontrado em 23% dos pacientes. Tumores do lado esquerdo foram mais comuns (43,6%), e a maioria dos pacientes foi diagnosticada em estágios avançados (34,7% no estágio III e 32,7% no estágio IV). A maioria dos pacientes (94,1%) apresentava sintomas, sendo o sangramento retal a apresentação clínica mais prevalente. O tipo histológico mais frequente foi adenocarcinoma moderadamente diferenciado (44,6%). Tumores com mutação KRAS foram encontrados em 18,8% e tumores com mutação BRAF em 11,9%. 67,3% apresentavam estabilidade de microssatélites. A recorrência do tumor ocorreu em 24,8% dos pacientes, enquanto 27,7% dos pacientes morreram. Conclusão: De 2010 a 2021, o CCR-IP representou 3% de todos os casos de câncer colorretal. Para melhorar o diagnóstico precoce e o tratamento, os médicos devem manter uma alta suspeita de sintomas de alerta em pacientes jovens. Para diminuir a morbidade e a mortalidade do CCR-IP, a consideração de iniciar exames de triagem diagnóstica aos 45 anos deve ser considerada.
ABSTRACT
Data on recurrent episodes of acute pancreatitis (RAP) are scarce. The aim of the study was to evaluate our rate of RAP and risks factors. This is a retrospective, single-center, study of consecutive patients admitted for AP and followed-up. Patients with more than one AP attack (RAP) were compared with patients with only a single AP episode (SAP) Clinical, demographic, outcome measures and severity were studied. 561 patients were included and follow-up over a mean 67.63 months' time. Our rate of RAP was 18,9%. Most patients suffered form only one episode of RAP (93%). Etiology of RAP episodes was mainly biliary (67%). On univariate analysis younger age (p 0.004), absence of high blood pressure (p 0.013) and absent of SIRS (p 0.022) were associated with recurrence of AP. On multivariate analysis only younger age was related to RAP (OR 1.015 95%IC 1.00-1.029). There were no statistical differences in outcome measures between both cohorts. RAP had a milder course in terms of severity (SAP 19% moderately severe/severe versus 9% in SAP). Almost 70% of the biliary RAP patients did not have a cholecystectomy performed. In this subset of patients, age OR 0.964 (95%IC 0.946-0.983), cholecystectomy OR 0.075 (95%IC 0.189-0.030) and cholecystectomy plus ERCP OR 0.190 (95%IC 0.219-0.055) were associated with absent of RAP. The rate of RAP in our series was 18,9%. Younger age was the only risk factor associated. Biliary etiology accounts for a large proportion of our RAP which could have been prevented with cholecystectomy or cholecystectomy plus ERCP.
La Pancreatitis Aguda Recurrente (PAR) es una entidad frecuente de la que hay pocos datos publicados. El objetivo del estudio es hallar la tasa y factores de riesgo asociados a PAR en nuestro medio. Es un estudio retrospectivo, unicéntrico, de pacientes ingresados por Pancreatitis Aguda (PA) y seguidos posteriormente. Se dividen en 2 grupos de pacientes: 1.- pacientes con un solo episodio de PA (PAS) y 2.- pacientes con más de un ingreso por PA (PAR). Se comparan variables clínicas, demográficas y de resultado. Resultados: 561 pacientes fueron incluidos y seguidos durante una media de 67,63 meses. 18,9% tuvieron al menos otro ingreso por PA. La mayoría sufrieron un solo episodio de PAR (93%). La etiología más frecuente fue biliar (67%). En el análisis univariado, una menor edad (p 0,004), la ausencia de hipertensión arterial (p 0,013) y de SIRS (p 0,022) se asociaron con PAR. En el análisis multivariado solo una menor edad se relacionó con PAR (OR 1,015, 95%, IC 1,00-1,029). No encontramos diferencias en las variables resultados entre ambos grupos. La PAR cursó de forma más leve (9% de pancreatitis moderada/graves o graves versus 19%). Casi un 70% de los pacientes con PAR biliar no tenían realizada una colecistectomía tras el ingreso índice. En este subgrupo de PAR, la edad OR 0,964 (95% IC 0,946-0,983), la colecistectomía OR 0,075 (95% IC 0,189-0,030) y la colecistectomía más colangiografía retrógrada OR 0,190 (95% IC 0,219-0,055) se asociaban a ausencia de PAR. Conclusión: Nuestra tasa de PAR fue 18,9%, con una menor edad como factor de riesgo. La etiología biliar fue la más frecuente que podría haberse evitado de haber realizado colecistectomía o colecistectomía más colangiografía retrógrada tras el primer ingreso.