Colorectal cancer in young patients: is it a distinct clinical entity?

Goldvaser, Hadar; Purim, Ofer; Kundel, Yulia; Shepshelovich, Daniel; Shochat, Tzippy; Shemesh-Bar, Lital; Sulkes, Aaron; Brenner, Baruch

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.

COLON cancer treatment; CANCER in young adults; DISEASE incidence; INFLAMMATORY bowel diseases; CLINICAL pathology; ONCOLOGY

International Journal of Clinical Oncology, 2016, Vol 21, Issue 4, p684

1341-9625

Academic Journal

10.1007/s10147-015-0935-z