The Impact of Age on Colorectal Cancer Incidence, Treatment, and Outcomes in an Equal-Access Health Care System

Steele, Scott R.; Park, Grace E.; Johnson, Eric K.; Martin, Matthew J.; Stojadinovic, Alexander; Maykel, Justin A.; Causey, Marlin Wayne

doi:10.1097/dcr.0b013e3182a586e7

Cited by 68 publications

(57 citation statements)

References 23 publications

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“…Whilst evidence for long-term survival for octogenarian patients has not been abundant in the literature, it is not unexpected that the limited evidence shows that the long-term survival for octogenarians who have undergone cancer resection surgery is poor [25,26]. Therefore, any small improvement that laparoscopic surgery is associated with in terms of longterm survival should be regarded as noteworthy.…”

Section: Discussionmentioning

confidence: 97%

Laparoscopic colorectal surgery is safe and benefits octogenarian patients with malignant disease: a matched case-control study comparing laparoscopic and open colorectal surgery

Koh

Wong

Tan

et al. 2015

Int J Colorectal Dis

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Section: Discussionmentioning

confidence: 97%

Laparoscopic colorectal surgery is safe and benefits octogenarian patients with malignant disease: a matched case-control study comparing laparoscopic and open colorectal surgery

Koh

Wong

Tan

et al. 2015

Int J Colorectal Dis

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“…More worryingly, its incidence in those ≤50 years of age has been increasing with the increased use of endoscopic evaluation [9][10][11]. In Singapore, the incidence of colorectal cancer was 22.5 per 100,000 per year for males between 40 and 49 years old and 20 per 100,000 per year for females of the same age group during the years 2010-2014 [8].…”

Section: Discussionmentioning

confidence: 99%

Is Colonoscopy Indicated in Young Patients with Hematochezia

Koh

Seah

Chan

et al. 2017

Gastrointest Tumors

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Background/Aims: While colonoscopy is indicated in patients >50 years old presenting with hematochezia, its role in those ≤50 remains debatable. This study aims to evaluate the role of colonoscopy in patients presenting with hematochezia who are ≤50 years old. Methods: A retrospective review of all patients aged ≤50 years who underwent colonoscopy for hematochezia in 2012 was conducted. Patient demographics, endoscopic details, and histological results were analyzed. Patients were stratified by age to compare differences in outcome. Results: A total of 361 patients with a median age of 44 (range, 18-50) years were reviewed. Hemorrhoid (n = 183, 69.6%) was the most common etiology. Seventy-two neoplastic polyps were identified in 48 (13.3%) patients. There was a significantly larger proportion of patients aged 41-50 years who had neoplastic polyps compared to those aged ≤40 (18.8 vs. 3.8%, p ≤ 0.001); 43.8% (n = 28) of the neoplastic polyps found in those aged 41-50 were proximal to the splenic flexure. The only 2 (0.5%) patients with malignancy were aged 41-50 years. Conclusion: Performing colonoscopy in patients presenting with hematochezia should be strongly considered for those aged 41-50 years in view of the significant likelihood of underlying neoplastic polyps compared to those aged ≤40 years.

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“…9 In particular, there is a paucity of outcome data concerning the proportion of patients with T1 node-positive disease. Although these patients represent a smaller proportion of patients who have node-positive colon cancer, compared with patients who have T2, T3, or T4 disease, approximately 3% to 17% of patients with a surgically staged T1 tumor will be found to be node positive.…”

mentioning

confidence: 99%

Adjuvant Chemotherapy for T1 Node-Positive Colon Cancers Provides Significant Survival Benefit

Ganapathi

Speicher

Englum

et al. 2014

Diseases of the Colon &Amp; Rectum

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BACKGROUND Contemporary treatment of node-positive (N+) colon cancer consists of adjuvant chemotherapy; however, randomized data supporting this practice were derived from lesions T2 or greater. Minimal data exist regarding the use and need for adjuvant chemotherapy in T1N+ disease. OBJECTIVE The aim of this study was to determine treatment trends and the effects of adjuvant chemotherapy on T1N+ colon cancers by using the National Cancer Database. DESIGN This was a retrospective study. Baseline demographics, tumor, and cancer treatment characteristics were compared. Groups were matched on the propensity to receive chemotherapy. Adjusted long-term survival stratified by chemotherapy use was compared by using the Kaplan-Meier method with the log-rank test. Predictors of not receiving chemotherapy were identified by using a multivariable logistic regression model. SETTINGS Data were collected from the National Cancer Database, which collects cancer data from over 1500 cancer centers. PATIENTS We identified patients from 1998 to 2006 with T1N+ disease, excluding those with metastatic disease or previous cancer. Patients were stratified based on whether or not they received chemotherapy. MAIN OUTCOME MEASURES The primary outcome measure of this study was long-term survival. RESULTS Three thousand one hundred thirty-seven patients had T1N+ disease; 70.6% (n = 2216) received chemotherapy, and utilization significantly increased from 1998 to 2011 (p < 0.001). Unadjusted analysis revealed that patients treated with chemotherapy were statistically younger and healthier, and had shorter postoperative lengths of stay (all p < 0.001). Unadjusted 5-year survival was higher in patients receiving chemotherapy (87.9% vs 63.0% in patients with no chemotherapy; p < 0.001) and this persisted after propensity matching with (83.4% and 63.0% in patients with or without chemotherapy; p < 0.001). Only age (OR, 0.29; p < 0.001) predicted not receiving chemotherapy. LIMITATIONS Limitations include potential selection bias as well as the inability to compare disease-free survival/ recurrence. CONCLUSIONS Adjuvant chemotherapy appears to significantly improve long-term survival in patients receiving chemotherapy in T1N+ disease. Thus, the use of chemotherapy in T1N+ disease is justified and provides a highly significant survival benefit.

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The Impact of Age on Colorectal Cancer Incidence, Treatment, and Outcomes in an Equal-Access Health Care System

Cited by 68 publications

References 23 publications

Laparoscopic colorectal surgery is safe and benefits octogenarian patients with malignant disease: a matched case-control study comparing laparoscopic and open colorectal surgery

Laparoscopic colorectal surgery is safe and benefits octogenarian patients with malignant disease: a matched case-control study comparing laparoscopic and open colorectal surgery

Is Colonoscopy Indicated in Young Patients with Hematochezia

Adjuvant Chemotherapy for T1 Node-Positive Colon Cancers Provides Significant Survival Benefit

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