Tumor location and patient characteristics of colon and rectal adenocarcinomas in relation to survival and TNM classes

Abstract

BackgroundOld age at diagnosis is associated with poor survival in colorectal cancer (CRC) for unknown reasons. Recent data show that colonoscopy is efficient in preventing left-sided cancers only. We examine the association of Tumor Node Metastasis (TNM) classes with diagnostic age and patient characteristics.MethodsThe Swedish Family-Cancer Database has data on TNM classes on 6,105 CRC adenocarcinoma patients. Ordinal logistic regression analysis was performed to model tumor characteristics according to age at diagnosis, tumor localization, gender, socioeconomic status, medical region and family history. The results were compared to results from survival analysis.ResultsThe only parameters systematically associated with TNM classes were age and tumor localization. Young age at diagnosis was a risk factor for aggressive CRC, according to stage, N and M with odds ratios (ORs) ranging from 1.80 to 1.93 for diagnosis before age 50 years compared to diagnosis at 80+ years. All tumor characteristics, particularly T, were worse for colon compared to rectal tumors. Right-sided tumors showed worse characteristics for all classifiers but M. The survival analysis on patients diagnosed since 2000 showed a hazard ratio of 0.55 for diagnosis before age 50 years compared to diagnosis at over 80 years and a modestly better prognosis for left-sided compared to right-sided tumors.ConclusionsThe results showed systematically more aggressive tumors in young compared to old patients. The poorer survival of old patients in colon cancer was not related to the available tumor characteristics. However, these partially agreed with the limited colonoscopic success with right-sided tumors.

Family history and the natural history of colorectal cancer: systematic review

“…Registry-based studies in Sweden and Japan suggested the majority of cancers in people with a family history were distally located. 33,36 However, two other studies found a more even distribution of distally and proximally located cancers. 32,34 In three studies providing data on stage at diagnosis by family history, there was no evidence of differential distributions of stage in people with a family history of CRC compared to those without.…”

Prognostic Implication of Urothelial Stem Cell Markers Differs According to Primary Tumour Location in Non-Muscle-Invasive Bladder Cancer

“…Kroman et al demonstrated that the clinical survival is significantly better for patients with a tumor in the upper lateral quadrant than that located elsewhere in the breast [36]. Hemminki et al reported that tumor location of colorectal cancer was closely related to TNM classes and survival [37]. Conversely, Li et al demonstrated that tumor location cannot be used to predict oncologic outcomes in patients with primary ureteral urothelial carcinoma [38].…”

Risk factors for colonic and rectal cancer mortality: evidence from 40 years' follow-up in the Whitehall I study

“…Such a misclassification might lead to a ‘reverse causal’ relationship biasing the unadjusted observation toward the null. The effect on survival may be more pronounced for rectal cancers because patients are aware of symptoms at an earlier stage than for colonic cancers 24. The induction period of smoking on colorectal cancer is usually at least 30 years and this may explain why former smokers remained at increased risk.…”