Zaid M Abdelsattar1,2, Sandra L Wong1, Scott E Regenbogen1, Diana M Jomaa3, Karin M Hardiman1, Samantha Hendren1. 1. Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan. 2. Department of Surgery, Mayo Clinic, Rochester, Minnesota. 3. College of Literature, Science and the Arts, University of Michigan, Ann Arbor, Michigan.
Abstract
BACKGROUND: Although colorectal cancer (CRC) screening guidelines recommend initiating screening at age 50 years, the percentage of cancer cases in younger patients is increasing. To the authors' knowledge, the national treatment patterns and outcomes of these patients are largely unknown. METHODS: The current study was a population-based, retrospective cohort study of the nationally representative Surveillance, Epidemiology, and End Results registry for patients diagnosed with CRC from 1998 through 2011. Patients were categorized as being younger or older than the recommended screening age. Differences with regard to stage of disease at diagnosis, patterns of therapy, and disease-specific survival were compared between age groups using multinomial regression, multiple regression, Cox proportional hazards regression, and Weibull survival analysis. RESULTS: Of 258,024 patients with CRC, 37,847 (15%) were aged <50 years. Young patients were more likely to present with regional (relative risk ratio, 1.3; P<.001) or distant (relative risk ratio, 1.5; P<.001) disease. Patients with CRC with distant metastasis in the younger age group were more likely to receive surgical therapy for their primary tumor (adjusted probability: 72% vs 63%; P<.001), and radiotherapy also was more likely in younger patients with CRC (adjusted probability: 53% vs 48%; P<.001). Patients younger than the recommended screening age had better overall disease-specific survival (hazards ratio, 0.77; P<.001), despite a larger percentage of these individuals presenting with advanced disease. CONCLUSIONS: Patients with CRC diagnosed at age <50 years are more likely to present with advanced-stage disease. However, they receive more aggressive therapy and achieve longer disease-specific survival, despite the greater percentage of patients with advanced-stage disease. These findings suggest the need for improved risk assessment and screening decisions for younger adults.
BACKGROUND: Although colorectal cancer (CRC) screening guidelines recommend initiating screening at age 50 years, the percentage of cancer cases in younger patients is increasing. To the authors' knowledge, the national treatment patterns and outcomes of these patients are largely unknown. METHODS: The current study was a population-based, retrospective cohort study of the nationally representative Surveillance, Epidemiology, and End Results registry for patients diagnosed with CRC from 1998 through 2011. Patients were categorized as being younger or older than the recommended screening age. Differences with regard to stage of disease at diagnosis, patterns of therapy, and disease-specific survival were compared between age groups using multinomial regression, multiple regression, Cox proportional hazards regression, and Weibull survival analysis. RESULTS: Of 258,024 patients with CRC, 37,847 (15%) were aged <50 years. Young patients were more likely to present with regional (relative risk ratio, 1.3; P<.001) or distant (relative risk ratio, 1.5; P<.001) disease. Patients with CRC with distant metastasis in the younger age group were more likely to receive surgical therapy for their primary tumor (adjusted probability: 72% vs 63%; P<.001), and radiotherapy also was more likely in younger patients with CRC (adjusted probability: 53% vs 48%; P<.001). Patients younger than the recommended screening age had better overall disease-specific survival (hazards ratio, 0.77; P<.001), despite a larger percentage of these individuals presenting with advanced disease. CONCLUSIONS:Patients with CRC diagnosed at age <50 years are more likely to present with advanced-stage disease. However, they receive more aggressive therapy and achieve longer disease-specific survival, despite the greater percentage of patients with advanced-stage disease. These findings suggest the need for improved risk assessment and screening decisions for younger adults.
Authors: Michael B Cook; Katherine A McGlynn; Susan S Devesa; Neal D Freedman; William F Anderson Journal: Cancer Epidemiol Biomarkers Prev Date: 2011-07-12 Impact factor: 4.254
Authors: Y Nancy You; Eric J Dozois; Lisa A Boardman; Jeremiah Aakre; Marianne Huebner; David W Larson Journal: Ann Surg Oncol Date: 2011-03-30 Impact factor: 5.344
Authors: H M Quah; R Joseph; D Schrag; J Shia; J G Guillem; P B Paty; L K Temple; W D Wong; M R Weiser Journal: Ann Surg Oncol Date: 2007-06-26 Impact factor: 5.344
Authors: Eric J Dozois; Lisa A Boardman; Weerapat Suwanthanma; Paul J Limburg; Robert R Cima; Julie L Bakken; Robert A Vierkant; Jeremiah A Aakre; David W Larson Journal: Medicine (Baltimore) Date: 2008-09 Impact factor: 1.889
Authors: Jessica B O'Connell; Melinda A Maggard; Jerome H Liu; David A Etzioni; Edward H Livingston; Clifford Y Ko Journal: World J Surg Date: 2004-06 Impact factor: 3.352
Authors: P Watson; K M Lin; M A Rodriguez-Bigas; T Smyrk; S Lemon; M Shashidharan; B Franklin; B Karr; A Thorson; H T Lynch Journal: Cancer Date: 1998-07-15 Impact factor: 6.860
Authors: Elena M Stoffel; Erika Koeppe; Jessica Everett; Peter Ulintz; Mark Kiel; Jenae Osborne; Linford Williams; Kristen Hanson; Stephen B Gruber; Laura S Rozek Journal: Gastroenterology Date: 2017-11-14 Impact factor: 22.682
Authors: Caitlin C Murphy; Robert S Sandler; Hanna K Sanoff; Y Claire Yang; Jennifer L Lund; John A Baron Journal: Clin Gastroenterol Hepatol Date: 2016-09-05 Impact factor: 11.382
Authors: Mohamed E Salem; Francesca Battaglin; Richard M Goldberg; Alberto Puccini; Anthony F Shields; David Arguello; W Michael Korn; John L Marshall; Axel Grothey; Heinz-Josef Lenz Journal: Oncologist Date: 2019-12-17
Authors: Jeremy R Burt; Jeffrey Waltz; Ashley Ramirez; Andres Abadia; Basel Yacoub; Sydney A Burt; Fiona Tissavirasingham; Madison R Kocher Journal: Abdom Radiol (NY) Date: 2020-09-16
Authors: Andreana N Holowatyj; Julie J Ruterbusch; Laura S Rozek; Michele L Cote; Elena M Stoffel Journal: J Clin Oncol Date: 2016-05-02 Impact factor: 44.544