Young patients with colorectal cancer have poor survival in the first twenty months after operation and predictable survival in the medium and long-term: Analysis of survival and prognostic markers

Abstract

ObjectivesThis study compares clinico-pathological features in young (<40 years) and older patients (>50 years) with colorectal cancer, survival in the young and the influence of pre-operative clinical and histological factors on survival.Materials and methodsA twelve year prospective database of colorectal cancer was analysed. Fifty-three young patients were compared with forty seven consecutive older patients over fifty years old. An analysis of survival was undertaken in young patients using Kaplan Meier graphs, non parametric methods, Cox's Proportional Hazard Ratios and Weibull Hazard models.ResultsYoung patients comprised 13.4 percent of 397 with colorectal cancer. Duration of symptoms and presentation in the young was similar to older patients (median, range; young patients; 6 months, 2 weeks to 2 years, older patients; 4 months, 4 weeks to 3 years, p > 0.05). In both groups, the majority presented without bowel obstruction (young - 81%, older - 94%). Cancer proximal to the splenic flexure was present more in young than in older patients. Synchronous cancers were found exclusively in the young. Mucinous tumours were seen in 16% of young and 4% of older patients (p < 0.05). Ninety four percent of young cancer deaths were within 20 months of operation. At median follow up of 50 months in the young, overall survival was 70% and disease free survival 66%. American Joint Committee on Cancer (AJCC) stage 4 and use of pre-operative chemoradiation in rectal cancer was associated with poor survival in the young.ConclusionIf patients, who are less than 40 years old with colorectal cancer, survive twenty months after operation, the prognosis improves and their survival becomes predictable.

Survival of Colorectal Cancer in the Presence of Competing-Risks - Modeling by Weibull Distribution

“…Colorectal cancer (CRC) is the commonest malignancy in the gastrointestinal tract (Chan et al, 2010) and common diagnosed cancer in both men and women. It is the third leading cause of cancer dependent death in the world and there are one million new cases diagnosed per year (Ranjbar1 et al, 2014).…”

Cancer genetics and the surgeon – new frontiers

“…A twelve year prospective database of colorectal cancer patients was analyzed by Chan et al to compare the clinico-pathological features in young (<40 years) and older (>50 years) patients. They observed that duration of symptoms and clinical presentation was similar in both groups [22]. Another comparative study on the clinico-pathological features of colorectal malignancies in Sri Lankan patients aged 40 years or younger and older patients conducted by De Silva et al reported that there is no difference in clinical presentation between the 2 groups.…”

Evaluation of Younger than Age 40 Years Patients Operated Due to Gastric, Colorectal and Pancreatic Cancer

“…In another study, the same value has been found to be. 10 3 months. 17 In our study, however, the mean survival rate for gastric cancer patients for 13.9± 7.8 months of follow-up was found to be 11.7±6.7 months.Our findings are in harmony with the literature.…”

“…Among the reasons for that, late diagnosis, advanced phase of tumors at the moment of diagnosis, and their more invasive, more aggressive and undifferentiated structure may be specified. 5,[7][8][9][10] Since the young adults seem healthier and cancer is generally recognized as the disease of advanced ages, the diagnosis is delayed and the disease is diagnosed in further phases 9 .…”