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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Article info
Publication history
Published online: July 02, 2018
Accepted:
June 27,
2018
Received in revised form:
June 18,
2018
Received:
April 13,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
