Hadar Goldvaser1, Ofer Purim1,2, Yulia Kundel1,2, Daniel Shepshelovich3,2, Tzippy Shochat4, Lital Shemesh-Bar5, Aaron Sulkes1,2, Baruch Brenner6,7. 1. Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 49100, Israel. 2. Sackler Faculty of Medicine, Tel Aviv University, P.O Box 39040, Tel Aviv, Israel. 3. Department of Medicine A, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, Israel. 4. Statistical Consulting Unit, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, Israel. 5. Maccabi Health Services, 33 Peres St., Rishon Lezion, Israel. 6. Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 49100, Israel. brennerb@clalit.org.il. 7. Sackler Faculty of Medicine, Tel Aviv University, P.O Box 39040, Tel Aviv, Israel. brennerb@clalit.org.il.
Abstract
BACKGROUND: The incidence of colorectal cancer in young patients is increasing. It remains unclear if the disease has unique features in this age group. METHODS: This was a single-center, retrospective cohort study which included patients diagnosed with colorectal cancer at age ≤40 years in 1997-2013 matched 1:2 by year of diagnosis with consecutive colorectal cancer patients diagnosed at age >50 years during the same period. Patients aged 41-50 years were not included in the study, to accentuate potential age-related differences. Clinicopathological characteristics, treatment, and outcome were compared between groups. RESULTS: The cohort included 330 patients, followed for a median time of 65.9 months (range 4.7-211). Several significant differences were noted. The younger group had a different ethnic composition. They had higher rates of family history of colorectal cancer (p = 0.003), hereditary colorectal cancer syndromes (p < 0.0001), and inflammatory bowel disease (p = 0.007), and a lower rate of polyps (p < 0.0001). They were more likely to present with stage III or IV disease (p = 0.001), angiolymphatic invasion, signet cell ring adenocarcinoma, and rectal tumors (p = 0.02). Younger patients more frequently received treatment. Young patients had a worse estimated 5-year disease-free survival rate (57.6 vs. 70 %, p = 0.039), but this did not retain significance when analyzed by stage (p = 0.092). Estimated 5-year overall survival rates were 59.1 and 62.1 % in the younger and the control group, respectively (p = 0.565). CONCLUSIONS: Colorectal cancer among young patients may constitute a distinct clinical entity. Further research is needed to validate our findings and define the optimal approach in this population.
BACKGROUND: The incidence of colorectal cancer in young patients is increasing. It remains unclear if the disease has unique features in this age group. METHODS: This was a single-center, retrospective cohort study which included patients diagnosed with colorectal cancer at age ≤40 years in 1997-2013 matched 1:2 by year of diagnosis with consecutive colorectal cancerpatients diagnosed at age >50 years during the same period. Patients aged 41-50 years were not included in the study, to accentuate potential age-related differences. Clinicopathological characteristics, treatment, and outcome were compared between groups. RESULTS: The cohort included 330 patients, followed for a median time of 65.9 months (range 4.7-211). Several significant differences were noted. The younger group had a different ethnic composition. They had higher rates of family history of colorectal cancer (p = 0.003), hereditary colorectal cancer syndromes (p < 0.0001), and inflammatory bowel disease (p = 0.007), and a lower rate of polyps (p < 0.0001). They were more likely to present with stage III or IV disease (p = 0.001), angiolymphatic invasion, signet cell ring adenocarcinoma, and rectal tumors (p = 0.02). Younger patients more frequently received treatment. Young patients had a worse estimated 5-year disease-free survival rate (57.6 vs. 70 %, p = 0.039), but this did not retain significance when analyzed by stage (p = 0.092). Estimated 5-year overall survival rates were 59.1 and 62.1 % in the younger and the control group, respectively (p = 0.565). CONCLUSIONS:Colorectal cancer among young patients may constitute a distinct clinical entity. Further research is needed to validate our findings and define the optimal approach in this population.
Authors: Scott R Steele; Grace E Park; Eric K Johnson; Matthew J Martin; Alexander Stojadinovic; J A Maykel; Marlin W Causey Journal: Dis Colon Rectum Date: 2014-03 Impact factor: 4.585
Authors: Matthew D Rutter; Brian P Saunders; Kay H Wilkinson; Steve Rumbles; Gillian Schofield; Michael A Kamm; Christopher B Williams; Ashley B Price; Ian C Talbot; Alastair Forbes Journal: Gastroenterology Date: 2006-04 Impact factor: 22.682