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Prognostic factors in colorectal carcinoma of young adults
M C Taylor1, D Pounder, N H Ali-Ridha
1Department of Surgery, Dalhousie University Medical School, Halifax, NS.
Insights
Colorectal cancer in adults under 40 has a poorer prognosis due to more aggressive disease, not delayed diagnosis. Young patients present with advanced stages and mucinous tumors, leading to lower survival rates.
Area of Science:
- Oncology
- Gastroenterology
- Clinical Medicine
Background:
- Colorectal cancer (CRC) prognosis is poorer in young adults.
- Factors contributing to this disparity require investigation.
Purpose of the Study:
- Compare survival and prognostic factors in CRC patients under 40 versus those aged 40-50.
- Identify reasons for the poorer prognosis in younger CRC patients.
Main Methods:
- Retrospective chart review of 122 CRC patients under 50 years old.
- Comparison of prognostic factors and survival rates between patients <40 and 40-50 years.
- 10-year study period at Victoria General Hospital, Halifax, NS.
Main Results:
- Patients <40 (n=34) had higher rates of advanced disease (Dukes' C/D: 67% vs 52%) and mucinous tumors (p=0.036).
- Younger patients presented with similar symptoms and durations but more advanced lesions.
- Actuarial survival rates were lower at all stages for patients <40.
Conclusions:
- Poorer CRC prognosis in young adults (<40) is attributed to more aggressive disease characteristics.
- Late diagnosis or symptom reporting is not the primary driver of poor outcomes.
- Disease aggressiveness, including advanced stage and mucinous histology, underlies the survival disparity.
Abstract:
To determine why the prognosis for colorectal cancer in young adults is poor, survival and prognostic factors in patients under 40 years of age were compared with those in patients between 40 and 50 years of age. In a 10-year period, 122 patients less than 50 years of age (88 between 40 and 50 years) presented at the Victoria General Hospital in Halifax, NS, with colorectal cancer. Their charts were retrospectively reviewed. Follow-up was obtained for all patients. Of the 34 patients younger than 40 years, 71% (24) were men compared with 38% (33) of older patients. Symptoms, their duration and the location of primary tumours were similar in the two groups. Patients younger than 40 years presented with advanced lesions (Dukes' stages C and D) in 67% of cases compared with 52% of the older group. Mucinous tumours were twice as common in patients less than 40 years old (p = 0.036) and actuarial survival rates were lower at all stages for the same group. The authors conclude that the poorer prognosis in patients less than 40 years of age is not due to late symptom reporting or delay in diagnosis, but to more aggressive disease.