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Disease Characteristics, Clinical Management, and Outcomes of Young Patients With Colon Cancer: A Population-based Study

  • Laura Rodriguez
    Affiliations
    Canadian Cancer Trials Group, Queen’s University, Kingston, ON, Canada
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  • Kelly Brennan
    Affiliations
    Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON, Canada
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  • Safiya Karim
    Affiliations
    Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON, Canada

    Department of Oncology, Queen’s University, Kingston, ON, Canada
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  • Sulaiman Nanji
    Affiliations
    Department of Oncology, Queen’s University, Kingston, ON, Canada

    Department of Surgery, Queen’s University, Kingston, ON, Canada
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  • Sunil V. Patel
    Affiliations
    Department of Oncology, Queen’s University, Kingston, ON, Canada

    Department of Surgery, Queen’s University, Kingston, ON, Canada
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  • Christopher M. Booth
    Correspondence
    Address for correspondence: Christopher M. Booth, MD, Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, 10 Stuart Street, Kingston, ON K7L 3N6, Canada
    Affiliations
    Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON, Canada

    Department of Oncology, Queen’s University, Kingston, ON, Canada

    Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada
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      Abstract

      Introduction

      The incidence of colorectal cancer in young patients has been increasing. We evaluated whether the disease characteristics, management, and outcomes of patients with colon cancer differ among patients aged ≤ 40 years compared with those of older patients.

      Materials and Methods

      Using the Ontario Cancer Registry, all cases of colon cancer (stage I, II, III) treated with surgery in Ontario from 2002 to 2008 were identified. The electronic medical records of treatment were used to identify the use of surgery and adjuvant chemotherapy (ACT). The pathology reports were obtained for a random 25% sample of all cases. A Cox model was used to identify the factors associated with overall (OS) and cancer-specific survival (CSS).

      Results

      The study population included 6775 patients. The age distribution was 2%, 5%, 14%, and 79% for patients aged ≤ 40, 41 to 50, 51 to 60, and > 60 years, respectively. Compared with patients aged > 60 years, younger patients (age ≤ 40 years) were more likely to have lymphovascular invasion (35% vs. 27%; P = .005), T3/T4 tumors (88% vs. 79%; P = .005) and lymph node–positive disease (58% vs. 41%; P < .001). The stage distribution varied by age: stage I, 8% versus 19%; stage II, 34% versus 40%; and stage III, 58% versus 41% for those aged ≤ 40 years versus those aged > 60 years, respectively (P < .001). ACT was delivered more often to patients aged ≤ 40 years than to those aged > 60 years for stage II (50% vs. 13%; P < .001) and stage III (≥ 92% vs. 57%; P < .001) disease. The adjusted OS (hazard ratio [HR], 0.32; 95% confidence interval [CI], 0.21-0.49) and CSS (HR, 0.41; 95% CI, 0.26-0.64) were superior for patients aged ≤ 40 years compared with the OS and CSS for those aged > 60 years.

      Conclusion

      Young patients with colon cancer have more aggressive and advanced disease but improved outcomes compared with older patients.

      Keywords

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      References

        • Canadian Cancer Society
        Canadian Cancer Statistics 2017. Toronto: Canadian Cancer Society.
        (Available at:)
        • National Cancer Institute
        SEER Cancer Stat Facts: Colon and Rectum Cancer. National Cancer Institute. Bethesda, MD.
        (Available at:)
        • Wang R.
        • Wang M.J.
        • Ping J.
        Clinicopathological features and survival outcomes of colorectal cancer in young versus elderly: a population-based cohort study of SEER 9 registries data (1988-2011).
        Medicine (Baltimore). 2015; 94: e1402
        • Ahnen D.J.
        • Wade S.W.
        • Jones W.F.
        • et al.
        The increasing incidence of young-onset colorectal cancer: a call to action.
        Mayo Clin Proc. 2014; 89: 216-224
        • Bailey C.E.
        • Hu C.Y.
        • You Y.N.
        • et al.
        Increasing disparities in the age-related incidences of colon and rectal cancers in the United States, 1975-2010.
        JAMA Surg. 2015; 150: 17-22
        • O'Connell J.B.
        • Maggard M.A.
        • Liu J.H.
        • Etzioni D.A.
        • Livingston E.H.
        • Ko C.Y.
        Do young colon cancer patients have worse outcomes?.
        World J Surg. 2004; 28: 558-562
        • Lee P.Y.
        • Fletcher W.S.
        • Sullivan E.S.
        • Vetto J.T.
        Colorectal cancer in young patients: characteristics and outcome.
        Am Surg. 1994; 60: 607-612
        • Leff D.R.
        • Chen A.
        • Roberts D.
        • et al.
        Colorectal cancer in the young patient.
        Am Surg. 2007; 73: 42-47
        • Paraf F.
        • Jothy S.
        Colorectal cancer before the age of 40: a case-control study.
        Dis Colon Rectum. 2000; 43: 1222-1226
        • Chung Y.F.
        • Eu K.W.
        • Machin D.
        • et al.
        Young age is not a poor prognostic marker in colorectal cancer.
        Br J Surg. 1998; 85: 1255-1259
        • Palmer M.L.
        • Herrera L.
        • Petrelli N.J.
        Colorectal adenocarcinoma in patients less than 40 years of age.
        Dis Colon Rectum. 1991; 34: 343-346
        • Marble K.
        • Banerjee S.
        • Greenwald L.
        Colorectal carcinoma in young patients.
        J Surg Oncol. 1992; 51: 179-182
        • Fu J.F.
        • Huang Y.Q.
        • Yang J.
        • Yi C.H.
        • Chen H.L.
        • Zheng S.
        Clinical characteristics and prognosis of young patients with colorectal cancer in Eastern China.
        World J Gastroenterol. 2013; 19: 8078-8084
        • Derwinger K.
        • Kodeda K.
        • Gerjy R.
        Age aspects of demography, pathology and survival assessment in colorectal cancer.
        Anticancer Res. 2010; 30: 5227-5231
        • Quah H.M.
        • Joseph R.
        • Schrag D.
        • et al.
        Young age influences treatment but not outcome of colon cancer.
        Ann Surg Oncol. 2007; 14: 2759-2765
        • Connell L.
        • MacDonald R.
        • McBride T.
        • et al.
        Observational studies: getting clear about transparency.
        PloS Med. 2014; 11: e1001711
        • Vandenbroucke J.P.
        • von Elm E.
        • Altman D.G.
        • et al.
        Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration.
        Ann Intern Med. 2007; 147: W163-W194
        • Clarke E.A.
        • Marrett L.D.
        • Kreiger N.
        Cancer registration in Ontario: a computer approach.
        IARC Sci Publ. 1991; 95: 246-257
        • Li X.
        • King C.
        • deGara C.
        • White J.
        • Winget M.
        Validation of colorectal cancer surgery data from administrative data sources.
        BMC Med Res Methodol. 2012; 12: 97
        • Mackillop W.J.
        • Zhang-Salomons J.
        • Groome P.A.
        • Paszat L.
        • Holowaty E.
        Socioeconomic status and cancer survival in Ontario.
        J Clin Oncol. 1997; 15: 1680-1689
        • Deyo R.A.
        • Cherkin D.C.
        • Ciol M.A.
        Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.
        J Clin Epidemiol. 1992; 45: 613-619
        • Murata A.
        • Akiyoshi T.
        • Ueno M.
        • et al.
        Clinicopathological characteristics of young patients with sporadic colorectal cancer.
        Surg Today. 2016; 46: 1166-1175
        • Canadian Task Force on Preventive Health Care
        Recommendations on screening for colorectal cancer in primary care.
        Can Med Assoc J. 2016; 188: 340-348
        • Scott R.B.
        • Rangel L.E.
        • Osler T.M.
        • Hyman N.H.
        Rectal cancer in patients under the age of 50 years: the delayed diagnosis.
        Am J Surg. 2016; 211: 1014-1018
        • Del Paggio J.C.
        • Nanji S.
        • Wei X.
        • MacDonald P.H.
        • Booth C.M.
        Lymph node evaluation for colon cancer in routine clinical practice: a population-based study.
        Curr Oncol. 2017; 24: e35-e43
        • Del Paggio J.C.
        • Peng Y.
        • Wei X.
        • et al.
        Population-based study to re-evaluate optimal lymph node yield in colonic cancer.
        Br J Surg. 2017; 104: 1087-1096
        • Baandrup L.
        • Thomsen L.T.
        • Olesen T.B.
        • Andersen K.K.
        • Norrild B.
        • Kjaer S.K.
        The prevalence of human papillomavirus in colorectal adenomas and adenocarcinomas: a systematic review and meta-analysis.
        Eur J Cancer. 2014; 50: 1446-1461