101
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Sioulas VD, Jorge S, Chern JY, Schiavone MB, Weiser MR, Kelvin JF, Gardner GJ, Sonoda Y, Abu-Rustum NR, Goodman KA, Leitao MM. Robotically Assisted Laparoscopic Ovarian Transposition in Women with Lower Gastrointestinal Cancer Undergoing Pelvic Radiotherapy. Ann Surg Oncol 2016; 24:251-256. [PMID: 27830391 DOI: 10.1245/s10434-016-5650-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND Pelvic radiotherapy (RT) is a standard component of the management for patients with locally advanced rectal cancer or squamous cell carcinoma of the anus. Pelvic RT leads to permanent and irreversible ovarian failure in young women. This study aimed to determine the effectiveness of robotically assisted laparoscopic ovarian transposition (OT) before RT in women with rectal or anal cancer who wanted to preserve normal ovarian function. METHODS The study reviewed the medical records of all patients treated at our institution from August 2009 to October 2014 who received robotically assisted laparoscopic OT for rectal or anal cancer before RT. Clinical and hormonal data were abstracted to determine ovarian function. RESULTS The study identified 22 women with rectal (n = 20) or anal (n = 2) cancer. The median age of the women was 39 years (range 26-45 years). For one patient, OT was technically not feasible. The postoperative course was uneventful in all but one case. Follow-up data on ovarian function were unavailable for 3 patients. The median times from RT initiation to the last gynecologic or hormonal evaluation were 9 months (range 5-47 months) and 10.5 months (range 5-47 months), respectively. At the last gynecologic or hormonal follow-up visit, ovarian function was preserved in 12 (67%) of 18 evaluable patients, including 9 (90%) of 10 patients 40 years of age or younger and 3 (38%) of 8 patients older than 40 years (P = 0.07). CONCLUSIONS Robotically assisted laparoscopic bilateral OT is safe and can lead to preservation of ovarian function in two-thirds of patients with low gastrointestinal cancer undergoing pelvic RT. It should be considered in this setting, especially for women age 40 years or younger, to avoid premature menopause and its associated sequelae.
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Affiliation(s)
- Vasileios D Sioulas
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Soledad Jorge
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jing-Yi Chern
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria B Schiavone
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin R Weiser
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joanne F Kelvin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Karyn A Goodman
- Department of Radiation Oncology, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Weill Cornell Medical College, New York, NY, USA.
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102
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Yong ZZ, Tan GHC, Wong JFS, Lim C, Soo KC, Teo MCC. Unresectability during open surgical exploration in planned cytoreductive surgery and hyperthermic intraperitoneal chemotherapy*. Int J Hyperthermia 2016; 32:889-894. [DOI: 10.1080/02656736.2016.1221146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Zachary Zihui Yong
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Grace Hwei Ching Tan
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Joelle Fui Sze Wong
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Cindy Lim
- Department of Clinical Trials and Epidemiological Science, National Cancer Centre Singapore, Singapore, Singapore
| | - Khee Chee Soo
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
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103
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Extending Colorectal Cancer Screening to Persons Aged 40 to 49 Years With Immunochemical Fecal Occult Blood Test: A Prospective Cohort Study of 513,283 Individuals. J Clin Gastroenterol 2016; 50:761-8. [PMID: 26905605 DOI: 10.1097/mcg.0000000000000495] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
GOALS To assess the association between the initial immunochemical fecal occult blood tests (FIT) and subsequent colorectal cancer, and to explore the ability of FIT to identify individuals age 40 to 49 years with a higher cancer risk. BACKGROUND The number of cancer cases in this age group is increasing globally and the cancers found in younger age tend to be more advanced than in older age. METHODS A total of 513,283 individuals had FIT as part of their self-paying medical screening program between 1994 and 2008. The initial FIT test was used. When matched with the Taiwan cancer registry, the cohort identified 2138 colorectal cancer cases. The number needed to screen (NNS) to identify 1 cancer was calculated from the reciprocal of cancer incidence cases during the study period. RESULTS One in 7 colorectal cancers above age 40 years occurred in the age group of 40 to 49 years. Individuals 40 to 49 years old with positive FIT (≥100 ng/mL) had a 3 times larger cancer risk than those 50 to 59 years old and without FIT, or double the cancer risk as those 50 to 69 years old and without FIT, with NNS at 42, 135, and 95, respectively. A similar relationship existed for the cancer incidence rate. The HR for ages 40 to 44 years or 45 to 49 years with a positive FIT was 2.3 or 5.7 times larger than the HR for ages 50 to 54 years. There was a dose-response relationship between increasing FIT values and the cancer risk for each age group, including ages 40 to 49 years. CONCLUSIONS Offering FIT to individuals 40 to 49 years of age could identify higher-risk individuals earlier for follow-up colonoscopy, and could, in turn, reduce cancer mortality.
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104
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Patterns and outcomes of colorectal cancer in adolescents and young adults. J Surg Res 2016; 205:19-27. [DOI: 10.1016/j.jss.2016.05.036] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/03/2016] [Accepted: 05/18/2016] [Indexed: 12/12/2022]
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105
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Lee J, Kim IH, Kim JS, Kim SW, Kim JG, Oh ST, Kang WK, Lee MA. Different clinical characteristics in sporadic young-age onset colorectal cancer. Medicine (Baltimore) 2016; 95:e4840. [PMID: 27631240 PMCID: PMC5402583 DOI: 10.1097/md.0000000000004840] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The incidence of colorectal cancer (CRC) is increasing in young-age patients, but the clinical history is not established. Authors analyzed the clinical characteristics of young-age onset CRC to support basic information for setting treatment policies.Between January 2006 to January 2014, 100 CRC patients diagnosed at the age of 10 to 39 were analyzed. The clinicopathologic characteristics were reviewed based on medical records. Survival outcomes including overall survival (OS), disease-free survival (DFS), and progression-free survival (PFS) were analyzed. This study was conducted as a retrospective, observation study.Among 100 patients, 86 patients were diagnosed as CRC at their thirties. Seventy-nine patients had no familial history of cancer. At initial diagnosis, 59 patients showed the normal CEA level (≤3 ng/mL), and 61 patients were diagnosed as advanced CRC (40% stage III, 21% stage IV). Sixty-four patients had lower location-sigmoid colon, rectosigmoid junction, or rectum. Recurrence rate was 7.9% in stage I to III CRC. Although median OS was not reached, patients with normal CEA level showed better survival outcome (P = 0.013) and patients with perineural invasion showed poorer survival (P = 0.011). The 5-year survival rate of total patient population was estimated as 75%. However, median OS of stage IV patients were 19 months (range 7.9-60.63 months), shorter than historical data of >24 months.Young-age CRC was most commonly diagnosed at their thirties, with no familial history, normal range of CEA and located below sigmoid colon. In young-age onset stage IV CRC, patients showed inferior OS compared to historical data. Based on our data, different surveillance program other than serum CEA level (e.g., sigmoidoscopy) is needed in young-age patient population.
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Affiliation(s)
- Jieun Lee
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, Cancer Research Institute, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - In-Ho Kim
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, Cancer Research Institute, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Jin Su Kim
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, Cancer Research Institute, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Sang Woo Kim
- Division of Gastroenterology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea
| | - Jun Gi Kim
- Department of Surgery, Seoul St. Mary's Hospial, The Catholic University of Korea
| | - Seung Tack Oh
- Department of Surgery, Seoul St. Mary's Hospial, The Catholic University of Korea
| | - Won Kyung Kang
- Department of Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea
| | - Myung Ah Lee
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, Cancer Research Institute, The Catholic University of Korea, College of Medicine, Seoul, Korea
- Correspondence: Myung Ah Lee, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea (e-mail: )
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Hemminki K, Pavlidis N, Tsilidis KK, Sundquist K, Ji J. Age-Dependent Metastatic Spread and Survival: Cancer of Unknown Primary as a Model. Sci Rep 2016; 6:23725. [PMID: 27009354 PMCID: PMC4806321 DOI: 10.1038/srep23725] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/14/2016] [Indexed: 01/21/2023] Open
Abstract
In order to describe a novel approach for the clinical study of metastases, we provide here age-specific incidence and survival data for cancer of unknown primary (CUP). Metastases in various organs are found at CUP diagnosis, which have implications for prognosis, and we hypothesize similar prognostic implications for metastases found at diagnosis of primary cancers. We identified 33,224 CUP patients from the Swedish Cancer Registry and calculated incidence rates (IRs) for CUP development. Cox proportional hazards regression models were performed to estimate hazard ratios (HRs) for relative survival in CUP patients compared to the general population. In age-group specific analyses, a maximal IR was reached at age 85-89 years, followed by a marked decline to age 90+ (7-fold in men and 3-fold in women). The overall HR for relative survival declined systematically by age. CUP may be applied as an epidemiological age-incidence model for cancer metastases providing evidence in line with autopsy data that the metastatic potential, as shown by the incidence of CUP, appears to weaken markedly at age 85 years, depending on metastatic locations. The relative death rates were highest among young patients, which was probably entirely due to the low death rates in young background population.
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Affiliation(s)
- Kari Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany.,Center for Primary Health Care Research, Lund University, 20502 Malmö, Sweden
| | - Nicholas Pavlidis
- Department of Medical Oncology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Konstantinos K Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, Ioannina 45110, Greece.,Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London W2 1PG, United Kingdom
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, 20502 Malmö, Sweden.,Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California 94305-5705, USA
| | - Jianguang Ji
- Center for Primary Health Care Research, Lund University, 20502 Malmö, Sweden
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107
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Vatandoust S, Price TJ, Ullah S, Roy AC, Beeke C, Young JP, Townsend A, Padbury R, Roder D, Karapetis CS. Metastatic Colorectal Cancer in Young Adults: A Study From the South Australian Population-Based Registry. Clin Colorectal Cancer 2016; 15:32-6. [PMID: 26341410 DOI: 10.1016/j.clcc.2015.07.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/20/2015] [Indexed: 02/07/2023]
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108
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Goldvaser H, Purim O, Kundel Y, Shepshelovich D, Shochat T, Shemesh-Bar L, Sulkes A, Brenner B. Colorectal cancer in young patients: is it a distinct clinical entity? Int J Clin Oncol 2016; 21:684-695. [PMID: 26820719 DOI: 10.1007/s10147-015-0935-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 11/26/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND The incidence of colorectal cancer in young patients is increasing. It remains unclear if the disease has unique features in this age group. METHODS This was a single-center, retrospective cohort study which included patients diagnosed with colorectal cancer at age ≤40 years in 1997-2013 matched 1:2 by year of diagnosis with consecutive colorectal cancer patients diagnosed at age >50 years during the same period. Patients aged 41-50 years were not included in the study, to accentuate potential age-related differences. Clinicopathological characteristics, treatment, and outcome were compared between groups. RESULTS The cohort included 330 patients, followed for a median time of 65.9 months (range 4.7-211). Several significant differences were noted. The younger group had a different ethnic composition. They had higher rates of family history of colorectal cancer (p = 0.003), hereditary colorectal cancer syndromes (p < 0.0001), and inflammatory bowel disease (p = 0.007), and a lower rate of polyps (p < 0.0001). They were more likely to present with stage III or IV disease (p = 0.001), angiolymphatic invasion, signet cell ring adenocarcinoma, and rectal tumors (p = 0.02). Younger patients more frequently received treatment. Young patients had a worse estimated 5-year disease-free survival rate (57.6 vs. 70 %, p = 0.039), but this did not retain significance when analyzed by stage (p = 0.092). Estimated 5-year overall survival rates were 59.1 and 62.1 % in the younger and the control group, respectively (p = 0.565). CONCLUSIONS Colorectal cancer among young patients may constitute a distinct clinical entity. Further research is needed to validate our findings and define the optimal approach in this population.
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Affiliation(s)
- Hadar Goldvaser
- Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 49100, Israel
| | - Ofer Purim
- Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, P.O Box 39040, Tel Aviv, Israel
| | - Yulia Kundel
- Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, P.O Box 39040, Tel Aviv, Israel
| | - Daniel Shepshelovich
- Department of Medicine A, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, P.O Box 39040, Tel Aviv, Israel
| | - Tzippy Shochat
- Statistical Consulting Unit, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, Israel
| | | | - Aaron Sulkes
- Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, P.O Box 39040, Tel Aviv, Israel
| | - Baruch Brenner
- Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 49100, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, P.O Box 39040, Tel Aviv, Israel.
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109
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Abdelsattar ZM, Wong SL, Regenbogen SE, Jomaa DM, Hardiman KM, Hendren S. Colorectal cancer outcomes and treatment patterns in patients too young for average-risk screening. Cancer 2016; 122:929-34. [PMID: 26808454 DOI: 10.1002/cncr.29716] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/22/2015] [Accepted: 08/28/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although colorectal cancer (CRC) screening guidelines recommend initiating screening at age 50 years, the percentage of cancer cases in younger patients is increasing. To the authors' knowledge, the national treatment patterns and outcomes of these patients are largely unknown. METHODS The current study was a population-based, retrospective cohort study of the nationally representative Surveillance, Epidemiology, and End Results registry for patients diagnosed with CRC from 1998 through 2011. Patients were categorized as being younger or older than the recommended screening age. Differences with regard to stage of disease at diagnosis, patterns of therapy, and disease-specific survival were compared between age groups using multinomial regression, multiple regression, Cox proportional hazards regression, and Weibull survival analysis. RESULTS Of 258,024 patients with CRC, 37,847 (15%) were aged <50 years. Young patients were more likely to present with regional (relative risk ratio, 1.3; P<.001) or distant (relative risk ratio, 1.5; P<.001) disease. Patients with CRC with distant metastasis in the younger age group were more likely to receive surgical therapy for their primary tumor (adjusted probability: 72% vs 63%; P<.001), and radiotherapy also was more likely in younger patients with CRC (adjusted probability: 53% vs 48%; P<.001). Patients younger than the recommended screening age had better overall disease-specific survival (hazards ratio, 0.77; P<.001), despite a larger percentage of these individuals presenting with advanced disease. CONCLUSIONS Patients with CRC diagnosed at age <50 years are more likely to present with advanced-stage disease. However, they receive more aggressive therapy and achieve longer disease-specific survival, despite the greater percentage of patients with advanced-stage disease. These findings suggest the need for improved risk assessment and screening decisions for younger adults.
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Affiliation(s)
- Zaid M Abdelsattar
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan.,Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sandra L Wong
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Scott E Regenbogen
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Diana M Jomaa
- College of Literature, Science and the Arts, University of Michigan, Ann Arbor, Michigan
| | - Karin M Hardiman
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Samantha Hendren
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Hassan AS, Naicker M, Yusof KH, Wan Ishak WZ. Prognostic factors and the role of adjuvant chemotherapy in post-curative surgery for Dukes B and C colon cancers and survival outcomes: a Malaysian experience. Asian Pac J Cancer Prev 2016; 16:2237-43. [PMID: 25824744 DOI: 10.7314/apjcp.2015.16.6.2237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adjuvant chemotherapy improves survival in Dukes C colon cancers post-curative resection. However, the evidence for a role with Dukes B lesions remains unproven despite frequent use for disease characterized by poor prognostic features. In view of limited Asia-specific data, this study aimed to determine survival outcomes and identify prognostic factors in a tertiary teaching hospital in Malaysia. MATERIALS AND METHODS A total of 116 subjects who underwent curative surgery with and without adjuvant chemotherapy for Duke B and C primary colon adenocarcinomas diagnosed from 2004-2009 were recruited and data were collected retrospectively. Five-year overall survival (OS) and disease free survival (DFS) were analysed using Kaplan-Meier survival analysis and log-rank (Mantel-Cox) test. Prognostic factors were determined using Cox proportional hazards regression with both univariate and multivariate analyses. RESULTS The survival analysis demonstrated a 5-year OS of 74.0% for all patients, with 74.9% for Dukes C subjects receiving chemotherapy compared to 28.6% in those not receiving chemotherapy (p=0.001). For Dukes B disease, the 5-year survival rate was 82.6% compared to 75.0% for subjects receiving and not receiving chemotherapy, respectively (p=0.17). Independent prognostic factors identified included a CEA level more than 3.5 ng/ml (hazard ratio (HR)=4.78; p=0.008), serosal involvement (HR=3.75; p=0.028) and completion of chemotherapy (HR= 0.20; p=0.007). CONCLUSIONS In a regional context, this study supports current evidence from the West that adjuvant chemotherapy improves survival in Dukes C colon cancers post curative surgery. However, although a clear benefit has yet to be proven for Dukes B disease, our results suggest survival improvement in selected cases.
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Affiliation(s)
- Astrid Sinarti Hassan
- Clinical Oncology Unit, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia E-mail :
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111
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Prognostic factors for patients with stage II colon cancer: results of a prospective study. Int J Colorectal Dis 2016; 31:123-9. [PMID: 26474869 DOI: 10.1007/s00384-015-2401-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE Many studies revealed that the recurrence rate of stage II colon cancer was up to 25–40 %. Regrettably, the risk factors for recurrence of stage II colon cancer remain ambiguous. So, we conducted this study to identify the clinicopathological factors associated with prognosis of stage II colon cancer. METHODS We enrolled 452 stage II colon cancer patients who underwent radical resection at Peking University Cancer Hospital between January 2007 and December 2010, and 162 patients who received adjuvant treatment were excluded. RESULTS The 5-year recurrence rate and overall survival of this cohort were 19.3 (56/290) and 75.9 % (220/290), respectively. In univariate analysis, the following variables were significantly associated with tumor recurrence:male patients (P<0.001), tumor size >5 cm (P=0.048), and preoperative carcinoembryonic antigen (CEA) level ≥ 5 ng/ml (P=0.004); the following factors were significantly associated with adverse 5-year overall survival:male patients (P<0.001), age ≥60 years old (P=0.004), less than 12 lymph nodes (P=0.006), and preoperative CEA level ≥5 ng/ml (P=0.011). In multivariate analysis,the preoperative CEA level ≥5 ng/ml (P=0.003) and male (P<0.001) were adverse variables significantly associated with tumor recurrence, and the preoperative CEA level ≥ 5 ng/ml (P=0.016), male (P<0.001), and age ≥60 years old (P=0.008) were independent prognostic factors for the 5-year overall survival rate, respectively. CONCLUSIONS The preoperative CEA level ≥5 ng/ml and male were undesirable factors significantly associated with tumor recurrence. The preoperative CEA level ≥5 ng/ml, male, and age ≥60 years old were adverse factors significantly associated with poor prognosis.
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112
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Grubman J, Barzi A. We Don't Know What We Don't Know About Adolescent and Young Adult Patients with Familial Adenomatous Polyposis-Related Colorectal Cancer. J Adolesc Young Adult Oncol 2015; 4:105-7. [PMID: 26421219 DOI: 10.1089/jayao.2015.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jessica Grubman
- Department of Obstetrics/Gynecology, University of Texas Southwestern Medical Center/Parkland Memorial Hospital , Dallas, TX
| | - Afsaneh Barzi
- Department of Hematology/Medical Oncology, Keck School of Medicine of the University of Southern California , Los Angeles, California
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113
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Ramzy I, Hasaballah M, Marzaban R, Shaker O, Soliman ZA. Evaluation of microRNAs-29a, 92a and 145 in colorectal carcinoma as candidate diagnostic markers: An Egyptian pilot study. Clin Res Hepatol Gastroenterol 2015; 39:508-15. [PMID: 25736690 DOI: 10.1016/j.clinre.2014.12.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 12/07/2014] [Accepted: 12/15/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is one of the most common malignant neoplasms in Egypt, and interestingly in young age. Adenomatous polyps and inflammatory bowel diseases (IBD) are considered the commonest pre-malignant lesions for CRC. A possible diagnostic role for different microRNAs on CRC has been suggested by numerous studies. AIM OF WORK To assess the serum expression of 3 microRNA markers (miR-29a, miR-92a and miR-145) in pre-malignant and malignant colorectal lesions. PATIENTS AND METHODS The 60 patients studied were divided into 4 groups: CRC group (25 patients), IBD group (11 patients), adenomatous polyps group (14 patients) and control group (10 patients). The serum expression of the 3 markers (miR-29a, miR-92a and miR-145) has been assessed by RT-PCR. RESULTS All CRCs were sporadic cases. Significant downregulation of miR-145 in CRC group was reported at all levels, i.e. when compared to normal, among the 3 studied groups, and when compared between CRC and non-CRC groups. Significant upregulation of miR-29a in CRC was reported when compared to normal, but no significant difference existed either among the 3 studied groups or between CRC and the other 2 groups. All 3 miRNAs studied were positively inter-correlated. CONCLUSIONS miR-145 may be considered a promising non-invasive reliable diagnostic marker in CRC. Extended studies are needed to ascertain the diagnostic role of miRNAs in CRC.
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Affiliation(s)
- Iman Ramzy
- Endemic Medicine and Hepatogastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maha Hasaballah
- Endemic Medicine and Hepatogastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Raghda Marzaban
- Endemic Medicine and Hepatogastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Olfat Shaker
- Medical Biochemistry, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Zienab A Soliman
- Endemic Medicine and Hepatogastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt
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114
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Elsamany SA, Alzahrani AS, Mohamed MM, Elmorsy SA, Zekri JE, Al-Shehri AS, Haggag RM, Alnagar AAR, El Taani HA. Clinico-pathological patterns and survival outcome of colorectal cancer in young patients: western Saudi Arabia experience. Asian Pac J Cancer Prev 2015; 15:5239-43. [PMID: 25040981 DOI: 10.7314/apjcp.2014.15.13.5239] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prognosis of young colorectal cancer (CRC) patients has been addressed by several studies but with contradictory results. The aim of the present study was to evaluate the clinico-pathological features of young Saudi patients with CRC in addition to displaying their survival outcome. MATERIALS AND METHODS In this retrospective study, young CRC patients (≤ 40 years) diagnosed between 2007 and 2011 from 4 centres in western Saudi Arabia, were included. Clinico-pathological features, tumor markers, dates of disease relapse and death were collected. Survival parameters were compared with those of older Saudi patients, reported in previous studies. RESULTS One hundred and sixteen young patients with CRC were identified (32.2% rectal, 67.8% colon). Some 44% were metastatic while 32.7% had stage III at diagnosis. Patients with grade 3 tumors made up 29.4% of the total while 49.5% had positive lymphovascular invasion (LVI), 56% had a lymph node (LN) ratio ≥ 0.2 and 40.2% were K-ras mutant. Median disease-free survival (DFS) and overall survival (OS) in non-metastatic cases were 22.8 and 49.6 months respectively with better median DFS in K-ras wild compared to mutant patients (28.5 vs 20.9 months, p=0.005). In metastatic cases, median OS was 19.5 months. These survival outcomes are inferior compared to those of older Saudi patients reported in prior studies. CONCLUSIONS Young CRC patients present more commonly with advanced stage and a high incidence of adverse prognostic factors such as LVI and high LN ratio. Young CRC patients seem to have worse survival compared to older Saudi patients.
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Affiliation(s)
- Shereef Ahmed Elsamany
- Department of Medical Oncology, Oncology centre, King Abdullah Medical City, Maddinah, Saudi Arabia E-mail :
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Jung YS, Ryu S, Chang Y, Yun KE, Park JH, Kim HJ, Cho YK, Sohn CI, Jeon WK, Kim BI, Park DI. Risk factors for colorectal neoplasia in persons aged 30 to 39 years and 40 to 49 years. Gastrointest Endosc 2015; 81:637-645.e7. [PMID: 25442324 DOI: 10.1016/j.gie.2014.09.031] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 09/10/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Very little is known about risk factors associated with colorectal neoplasia in persons aged <50 years. In particular, there has been no study thus far focusing on the risk factors for colorectal neoplasia in persons aged 30 to 39 years. OBJECTIVE To investigate risk factors for colorectal neoplasia in persons aged 30 to 39 years and 40 to 49 years and to compare those data with those of persons aged 50 to 59 years. DESIGN Cross-sectional observational study. SETTING Screening center in a university hospital in Korea. PATIENTS A cohort of 28,504 Korean adults (13,678 aged 30-39 years, 12,507 aged 40-49 years, and 2319 aged 50-59 years) who underwent colonoscopy as part of their routine preventive health care. INTERVENTIONS Colonoscopy. MAIN OUTCOME MEASUREMENTS Risk factors for colorectal neoplasia in persons aged 30 to 39 years and 40 to 49 years. RESULTS In the 30-to-39-years group, male sex, smoking, fatty liver, metabolic syndrome (MetS), obesity, elevated fasting blood glucose levels, and elevated triglyceride levels were associated with overall neoplasia, whereas for advanced neoplasia, the independent risk factors were smoking, fatty liver, and elevated triglyceride levels. Moreover, the prevalence of overall neoplasia in men aged 30 to 39 years exhibiting all risk factors was not lower than that in average-risk women aged >50 years (20.8% vs 18.8%; P = .546). The risk factors of overall neoplasia in the 40-to-49-years group were similar to those in the 30-to-39-years group. For advanced neoplasia, the independent risk factors in the 40-to-49-years group were male sex, smoking, MetS, and obesity. LIMITATIONS Selection bias may exist for participants of ethnic Korean heritage in 2 centers. CONCLUSION Obese male smokers with fatty liver and MetS might benefit from screening colonoscopy starting before age 50 years.
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Affiliation(s)
- Yoon Suk Jung
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Seungho Ryu
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea; Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Yoosoo Chang
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea; Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Kyung Eun Yun
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jung Ho Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Hong Joo Kim
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Yong Kyun Cho
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Chong Il Sohn
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Woo Kyu Jeon
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Byung Ik Kim
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Dong Il Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea
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Abstract
The incidence and mortality rates of colorectal cancer (CRC) have been decreasing in adults over 50 years of age, however, these rates have been increasing in adults under 50. The majority of CRC in young adults is sporadic, and is likely due to behavioral and environmental causes, however the exact etiology still remains unclear. The minority of CRC in this population is due to inherited CRC syndromes. Young adults with CRC are often symptomatic (abdominal pain, rectal bleeding), and diagnosis is often delayed due to reasons such as under-utilized health care services, and physicians attributing symptoms to diagnoses other than CRC. Young adults with CRC often have more aggressive tumor characteristics, but they tend to have better survival rates when compared with older adults when matched for stage. Treatment is the same for young patients with CRC, however there are issues that arise in this population that do not necessarily affect older adults, such as the negative effect of chemotherapy/radiation on fertility. It is not clear that screening individuals for CRC at ages under 50 is beneficial or cost-effective. Further studies are needed regarding this topic.
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Affiliation(s)
- Jennifer A Inra
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA, USA,
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Renfro LA, Grothey A, Kerr D, Haller DG, André T, Van Cutsem E, Saltz L, Labianca R, Loprinzi CL, Alberts SR, Schmoll H, Twelves C, Yothers G, Sargent DJ. Survival following early-stage colon cancer: an ACCENT-based comparison of patients versus a matched international general population†. Ann Oncol 2015; 26:950-958. [PMID: 25697217 DOI: 10.1093/annonc/mdv073] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 02/05/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Post-treatment survival experience of early colon cancer (CC) patients is well described in the literature, which states that cure is probable for some patients. However, comparisons of treated patients' survival versus that expected from a matched general population (MGP) are limited. PATIENTS AND METHODS A total of 32 745 patients from 25 randomized adjuvant trials conducted from 1977 to 2012 in 41 countries were pooled. Observed long-term survival of these patients was compared with expected survival matched on sex, age, country, and year, both overall and by stage (II and III), sex, treatment [surgery, 5-fluorouracil (5-FU), 5-FU + oxaliplatin], age (<70 and 70+), enrollment year (pre/post 2000), and recurrence (yes/no). Comparisons were made at randomization and repeated conditional on survival to 1, 2, 3, and 5 years. CC and MGP equivalence was tested, and observed Kaplan-Meier survival rates compared with expected MGP rates 3 years out from each landmark. Analyses were also repeated in patients without recurrence. RESULTS Within most cohorts, long-term survival of CC patients remained statistically worse than the MGP, though conditional survival generally improved over time. Among those surviving 5 years, stage II, oxaliplatin-treated, elderly, and recurrence-free patients achieved subsequent 3-year survival rates within 5% of the MGP, with recurrence-free patients achieving equivalence. CONCLUSIONS Conditional on survival to 5 years, long-term survival of most CC patients on clinical trials remains modestly poorer than an MGP, but achieves MGP levels in some subgroups. These findings emphasize the need for access to quality care and improved treatment and follow-up strategies.
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Affiliation(s)
- L A Renfro
- Division of Biomedical Statistics and Informatics.
| | - A Grothey
- Department of Oncology, Mayo Clinic, Rochester, USA
| | - D Kerr
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - D G Haller
- School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - T André
- Hôpital Saint Antoine, Paris; Pierre and Marie Curie University, Paris, France
| | - E Van Cutsem
- Digestive Oncology Unit, University Hospital Gasthuisberg/Leuven, Leuven, Belgium
| | - L Saltz
- Gastrointestinal Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - R Labianca
- Oncology Unit, Ospedale Giovanni XXIII, Bergamo, Italy
| | - C L Loprinzi
- Department of Oncology, Mayo Clinic, Rochester, USA
| | - S R Alberts
- Department of Oncology, Mayo Clinic, Rochester, USA
| | - H Schmoll
- Department for Internal Medicine IV, University Clinic Halle, Halle, Germany
| | - C Twelves
- Leeds Institute of Cancer and Pathology, University of Leeds and St James's University Hospital, Leeds Cancer Research UK Centre, Leeds, UK
| | - G Yothers
- National Surgical Adjuvant Breast and Bowel Project Biostatistical Center, Pittsburgh, USA
| | - D J Sargent
- Division of Biomedical Statistics and Informatics
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Lieu CH, Renfro LA, de Gramont A, Meyers JP, Maughan TS, Seymour MT, Saltz L, Goldberg RM, Sargent DJ, Eckhardt SG, Eng C. Association of age with survival in patients with metastatic colorectal cancer: analysis from the ARCAD Clinical Trials Program. J Clin Oncol 2015; 32:2975-84. [PMID: 25002720 DOI: 10.1200/jco.2013.54.9329] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This study addressed whether age is prognostic for overall survival (OS) or progression-free survival (PFS) in patients with metastatic colorectal cancer (mCRC). PATIENTS AND METHODS A total of 20,023 patients from 24 first-line clinical trials in the ARCAD (Aide et Recherche en Cancérologie Digestive) database were analyzed. Primary age effects and interactions with age,sex, performance status (PS), and metastatic site were modeled using Cox proportional hazards stratified by treatment arm within study. RESULTS Of total patients, 3,051 (15%) were age < or =50 years. Age was prognostic for both OS (P < .001)and PFS (P < .001), with U-shaped risk (i.e., highest risk was evident in youngest and oldest patients). Relative to patients of middle age, the youngest patients experienced 19% (95% CI, 7% to 33%) increased risk of death and 22% (95% CI, 10% to 35%) increased risk of progression. The oldest patients experienced 42% (95% CI, 31% to 54%) increased risk of death and 15% (95% CI, 7% to 24%) increased risk of progression or death. This relationship was more pronounced in the first year of follow-up. Age remained marginally significant for OS (P = .08) when adjusted forPS, sex, and presence of liver, lung, or peritoneal metastases, and age was significant in an adjusted model for PFS (P = .005). The age effect did not differ by site of metastatic disease, year of enrollment, type of therapy received, or biomarker mutational status. CONCLUSION Younger and older age are associated with poorer OS and PFS among treated patients with mCRC. Younger and older patients may represent higher-risk populations, and additional studies are warranted.
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Young JP, Win AK, Rosty C, Flight I, Roder D, Young GP, Frank O, Suthers GK, Hewett PJ, Ruszkiewicz A, Hauben E, Adelstein BA, Parry S, Townsend A, Hardingham JE, Price TJ. Rising incidence of early-onset colorectal cancer in Australia over two decades: report and review. J Gastroenterol Hepatol 2015; 30:6-13. [PMID: 25251195 DOI: 10.1111/jgh.12792] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2014] [Indexed: 12/09/2022]
Abstract
The average age at diagnosis for colorectal cancer (CRC) in Australia is 69, and the age-specific incidence rises rapidly after age 50 years. The incidence has stabilized or is declining in older age groups in Australia during recent decades, possibly related to the increased uptake of screening and high-risk surveillance. In the same time frame, a rising incidence of CRC in younger adults has been well-documented in the United States. This rise in incidence in the young has not been reported from other countries that share long-term exposure to westernised urban lifestyles. Using data from the Australian Institute of Health and Welfare, we examined trends in national incidence rates for CRC under age 50 years and observed that rates in people under age 40 years have been rising for the last two decades. We further performed a review of the literature regarding CRC in young adults to outline the extent of current understanding, explore potential risk factors such as obesity, alcohol, and sedentary lifestyles, and to identify the questions remaining to be addressed. Although absolute numbers might not justify a population screening approach, the dispersal of young adults with CRC across the primary health-care system decreases probability of their recognition. Patient and physician awareness, aided by stool and emerging blood-screening tests and risk profiling tools, have the potential to aid in identification of those young adults who would most benefit from a colonoscopy through early detection of CRCs or by removal of advanced polyps.
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Affiliation(s)
- Joanne P Young
- Department of Haematology and Oncology, The Queen Elizabeth Hospital, Woodville, South Australia, Australia; South Australian Health and Medical Research Institute (SAHMRI) Colorectal Node, Basil Hetzel Institute for Translational Research, Woodville, South Australia, Australia; School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Fu J, Yang J, Tan Y, Jiang M, Wen F, Huang Y, Chen H, Yi C, Zheng S, Yuan Y. Young patients (≤ 35 years old) with colorectal cancer have worse outcomes due to more advanced disease: a 30-year retrospective review. Medicine (Baltimore) 2014; 93:e135. [PMID: 25415667 PMCID: PMC4616343 DOI: 10.1097/md.0000000000000135] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
An appropriate cutoff of age and the impact of age on colorectal cancer outcomes remain unclear and need to be explored, particularly in China.In total, 2460 colorectal cancer patients were studied retrospectively. All patients were divided into 6 groups according to their ages at the time of diagnosis: ≤ 30, 31 to 35, 36 to 40, 41 to 45, 46 to 50, and ≥ 50 years. A suitable cutoff age for defining young adult colorectal cancer was explored according to the distribution of survival in each group. Clinical characteristics and prognosis between the young adult group and the older group were then compared.According to the survival curves for each group, 35 years old was considered a suitable cutoff age for defining young adult colorectal cancer. There were 140 (5.7%) and 2320 (94.3%) cases in the young adult and older groups, respectively. The proportion of stage III-IV tumors was significantly higher in the young adult group (69.3%) than in the older group (46.4%) (P = 0.000). The univariate analysis showed that the 5-year overall survival (OS) rate and the 10-year OS rate in the young adult group were 48.9% and 38.6%, respectively, whereas in the older group, they were 63.6% and 56.9%, respectively. The young adult group had a worse prognosis (P = 0.000). The multivariate analysis showed that age was not an independent prognostic factor (relative risk 0.787, P = 0.062). After adjusting for tumor stage, the hazard proportion of death in the young adult group increased by 27.6%, but this difference was not significant (P = 0.053). Stratified analyses showed that the young adults with stage IV tumors had a worse survival rate (P = 0.046).Patients ≤ 35 years who were diagnosed with colorectal cancer had a worse prognosis because of a higher proportion of advanced stage tumors. When stage-to-stage analysis was performed, it was found that young adult colorectal cancer patients had a worse outcome only if they had stage IV tumors.
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Affiliation(s)
- Jianfei Fu
- From the The Key Laboratory of Cancer Prevention and Intervention, Chinese Ministry of Education; Key Laboratory of Molecular Biology in Medical Sciences; Cancer Institute, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou (JF, JY, YT, MJ, FW, YH, HC, CY, SZ); Department of Oncology, Jinhua Central Hospital, (Jinhua Hospital of Zhejiang University School of Medicine), Jinhua City (JF); and Department of Medical Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China (JY, YT, MJ, YY)
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121
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Baseline mortality-adjusted survival in resected rectal cancer patients. J Gastrointest Surg 2014; 18:1837-44. [PMID: 25091850 DOI: 10.1007/s11605-014-2618-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 07/23/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND This investigation assessed the baseline mortality-adjusted 5-year survival after open rectal cancer resection. METHODS The 5-year survival rate was analyzed in 885 consecutive American Joint Committee on Cancer (AJCC) stage I-IV rectal cancer patients undergoing open resection between 2002 and 2011 using risk-adjusted Cox proportional hazards regression models adjusted for population-based baseline mortality. RESULTS The 5-year relative and overall survival rates were 80.9%(95% confidence interval (CI): 77.0-85.0%) and 71.9%(95% CI, 68.4-75.5%), respectively. The 5-year relative survival rates for stage I, II, III, and IV cancer were 97.8% (95% CI, 93.1-102.8%), 90.9%(95% CI, 84.3-98.1%), 72.0% (95% CI, 64.7-80.1%), and 24.4% (95% CI: 16.0-37.0%), respectively. After the curative resection of stage I-III rectal cancer, fewer than every other observed death was cancer-related. The 5-year relative survival rate for stage I cancer did not differ from the matched average national baseline mortality rate (P = 0.419). Higher age (hazard ratio (HR) 0.94, 95% CI: 0.92-0.95, P < 0.001) was protective for relative survival but unfavorable for overall survival (HR 1.04, 95% CI: 1.02-1.05, P < 0.001). Female gender was only unfavorable for relative survival (HR 1.59, 95% CI: 1.11-2.29, P = 0.014). CONCLUSION The analysis of relative survival in a large cohort of rectal cancer patients revealed that stage I rectal cancer is fully curable. The findings regarding age and gender may explain the conflicting results obtained to date from studies based on overall survival.
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Incidence of chemotherapy- and chemoradiotherapy-induced amenorrhea in premenopausal women with stage II/III colorectal cancer. Clin Colorectal Cancer 2014; 14:31-4. [PMID: 25446053 DOI: 10.1016/j.clcc.2014.09.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/15/2014] [Accepted: 09/17/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND The incidence rates of colorectal cancer (CRC) in young individuals are increasing. There has been a significant improvement in overall survival in CRC because of advances in adjuvant chemotherapy and chemoradiotherapy over the past decades. However, these procedures may compromise the function of the reproductive system, and ovarian failure and premature menopause may occur. The objective of this analysis was to determine the incidence of long-term amenorrhea (≥ 12 months) in women with CRC aged 40 years and younger after adjuvant treatment. PATIENTS AND METHODS The authors identified 162 premenopausal women with CRC aged 40 years or younger who were treated with adjuvant chemotherapy and chemoradiotherapy at Fudan University Shanghai Cancer Center from January 2008 to December 2012. One hundred twenty-three patients met all eligibility criteria and had sufficient follow-up for evaluation. The median age at diagnosis in patients with colon and rectal cancers was, respectively, 36 and 35 years (range, 17-40 and 24-40 years). RESULTS All patients had regular menses before treatment; 3 patients with colon cancer (4.2%) experienced long-term amenorrhea, and 48 patients with rectal cancer (94.1%) experienced long-term amenorrhea. The incidence of amenorrhea was significantly lower in patients with colon cancer (4.2%; 3 of 72) than in patients with rectal cancer (94.1%; 48 of 51) (P < .01). CONCLUSION In this retrospective series, the incidence of amenorrhea in patients with colon and rectal cancers was 4.2% and 94.1%, respectively. We believe our data support the fact that young female patients with CRC, especially those with rectal cancer who are scheduled to undergo pelvic irradiation, should be counseled regarding fertility preservation options, including ovarian transposition and cryopreservation of ovarian tissue, embryo, or oocyte.
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Teo MCC, Ching Tan GH, Lim C, Chia CS, Tham CK, Soo KC. Colorectal peritoneal carcinomatosis treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: the experience of a tertiary Asian center. Asian J Surg 2014; 38:65-73. [PMID: 25059814 DOI: 10.1016/j.asjsur.2014.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/01/2014] [Accepted: 05/12/2014] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Compared with intravenous chemotherapy, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been shown to improve survival in patients with recurrent colorectal disease confined to the peritoneum. We report our experience with CRS and HIPEC for colorectal cancer patients with peritoneal carcinomatosis, evaluating prognostic factors for disease-free survival (DFS), overall survival (OS), and perioperative morbidity and mortality. METHODS All patients who underwent CRS and HIPEC were included in our study. Clinical characteristics, operative data, and 30-day morbidity and mortality were collected and evaluated. RESULTS Between January 2001 and December 2012, there were 35 consecutive patients who underwent CRS and HIPEC at our institution. Thirty-three patients (94%) had optimal cytoreduction. No 30-day mortality was reported, but 14 patients had postoperative complications. The median DFS was 9.4 months (95% confidence interval 5.5-18.7 months), and DFS at 1 year, 3 years, and 5 years were 43.8%, 22.3%, and 22.3%, respectively. The median OS was calculated to be 27.1 months (95% confidence interval 15.3-39.1), and the OS at 1 year, 3 years, and 5 years were 83.7%, 38.2%, and 19.1%, respectively. CONCLUSION CRS and HIPEC can provide survival benefit, with reasonable morbidity and mortality for Asian patients with peritoneal carcinomatosis from colorectal cancer. Patient selection and perioperative management of the patients are key to the success of the procedure.
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Affiliation(s)
- Melissa Ching Ching Teo
- Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, 169610 Singapore; Department of General Surgery, Singapore General Hospital, 9 Hospital Drive, 169612 Singapore.
| | - Grace Hwei Ching Tan
- Department of General Surgery, Singapore General Hospital, 9 Hospital Drive, 169612 Singapore
| | - Cindy Lim
- Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, 169610 Singapore
| | - Claramae Shulyn Chia
- Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, 169610 Singapore
| | - Chee Kian Tham
- Department of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, 169610 Singapore
| | - Khee-Chee Soo
- Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, 169610 Singapore; Department of General Surgery, Singapore General Hospital, 9 Hospital Drive, 169612 Singapore
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Klos CL, Montenegro G, Jamal N, Wise PE, Fleshman JW, Safar B, Dharmarajan S. Segmental versus extended resection for sporadic colorectal cancer in young patients. J Surg Oncol 2014; 110:328-32. [PMID: 24888987 DOI: 10.1002/jso.23649] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 04/17/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Guidelines on the management of colon cancer state that extensive colectomy should be "considered" for patients of young age (<50). This study aimed to compare the risk of metachronous cancer, overall recurrence and mortality between segmental and extended colon resections in patients under the age of 50 with sporadic CRC. METHODS We performed a retrospective review of patients age <50 undergoing surgery for CRC from 1991 to 2009. Patients were divided into two groups based on extent of resection: segmental versus extended. The primary outcomes analyzed were metachronous tumors, disease recurrence, and overall survival. RESULTS Two hundred seventy one patients underwent segmental resection and 30 underwent extended resection. 3.3% in the segmental resection group developed metachronous CRC versus 0% in the extended resection group (P = 0.61). There was no significant difference in the risk of recurrence or mortality for those who underwent a segmental resection compared to those with an extended resection. In a regression model, type of surgery was not an independent risk factor for recurrence or mortality. CONCLUSIONS Extended colectomy for sporadic CRC in patients younger than 50 does not improve disease-free or overall survival. Further study to determine if segmental resection is appropriate oncologic treatment is warranted.
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Affiliation(s)
- Coen L Klos
- Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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125
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Ramireddy L, Chen WTL, Peng CT, Hu RM, Ke TW, Chiang HC, Chang SC, Tsai FJ, Lo WY. Association Between Genetic Polymorphism of the MIF Gene and Colorectal Cancer in Taiwan. J Clin Lab Anal 2014; 29:268-74. [PMID: 24840392 DOI: 10.1002/jcla.21763] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 03/14/2014] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the highest leading cause of cancer-related mortality in Taiwan. Macrophage migration inhibitory factor (MIF) has recently been defined as a novel protumorigenic factor that promotes cell proliferation, migration, and invasion. The aim of the present study is to identify the association between MIF gene polymorphism and CRC. METHODS A case-control study was designed to test the hypothesis. A total of 192 biopsy-diagnosed CRC patients (CRC) and 256 healthy subjects (control) were recruited. Genotyping of four single nucleotide polymorphism (SNPs; rs755662, rs11548059, rs1049829, rs1803976) at chromosome positions 755662 (5' UTR), 11548059 (exon2), 1049829 (exon2), 1803976 (exon3) was performed using a Taqman SNP genotyping assay. RESULTS There is a significant difference in genotype frequency distribution of rs755662 polymorphism between CRC patients and controls (P = 0.011). No significant difference was found in the frequency distribution of rs11548059, rs1049829, rs1803976 polymorphism in CRC patients and controls (P = 0.660, P = 0.700, and P = 0.959, respectively). Moreover, the MIF-173 SNP was also significantly associated with young patients (age < 50 years, P = 0.026) late stage (Stage IV, P = 0.038) and poor differentiation group (P = 0.040). Compared to the control group, the MIF-173 SNP also significantly associated with patients with stages III and IV (P = 0.034 and 0.003, respectively). CONCLUSION The presence of MIF-173 (G/C) gene polymorphism (rs755662) was associated with susceptibility, patient age, and stages of CRC in Taiwanese.
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Affiliation(s)
- Latha Ramireddy
- Department of Biomedical Informatics, Asia University, Taichung, Taiwan
| | - William Tzu-Liang Chen
- Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Ching-Tien Peng
- Department of Biomedical Informatics, Asia University, Taichung, Taiwan.,Department of Pediatrics, Children's Hospital, China Medical University, Taichung, Taiwan
| | - Rouh-Mei Hu
- Department of Biomedical Informatics, Asia University, Taichung, Taiwan
| | - Tao-Wei Ke
- Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Hua-Che Chiang
- Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Sheng-Chi Chang
- Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Fuu-Jen Tsai
- Department of Pediatrics, Children's Hospital, China Medical University, Taichung, Taiwan
| | - Wan-Yu Lo
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.,Department of Life Science, National Chung Hsing University, Taichung, Taiwan
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Park SH, Song CW, Kim YB, Kim YS, Chun HR, Lee JH, Seol WJ, Yoon HS, Lee MK, Lee JH, Bhang CS, Park JH, Park JY, Do BH, Park YD, Yoon SJ, Park CW, Yoon SM, Choi JH, Shin KC, Ko DH, Kim YJ, Seol DC. Clinicopathological characteristics of colon cancer diagnosed at primary health care institutions. Intest Res 2014; 12:131-8. [PMID: 25349580 PMCID: PMC4204700 DOI: 10.5217/ir.2014.12.2.131] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 12/04/2013] [Accepted: 12/05/2013] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND/AIMS The purpose of this study was to evaluate the clinicopathologic characteristics of colon cancers detected at the SOK Sokpeynhan Internal Medical Network, a nationwide system of primary health care institutions. METHODS We analyzed 579 colon cancer patients diagnosed using colonoscopy at the SOK network from January 2011 through December 2012. Cancers from the rectum to the splenic flexure were classified as left colon cancer. Patients over 65 were classified as senior. RESULTS The mean age (±SD) of subjects was 60.9±10.5 years and 61.1% were men. More than one quarter (28.2%) of patients were asymptomatic. The prevalence of left colon cancer was higher (77.9%) than that for right colon cancer. The most frequent macroscopic and histologic types were depressed (58.9%) and moderately differentiated adenocarcinoma (52.2%), respectively. Asymptomatic subjects displayed protruding or well differentiated adenocarcinoma, while symptomatic patients were more likely to display depressed or moderately differentiated adenocarcinoma (P<0.05). The mean age of the right colon cancer group was higher than that for the left colon cancer group (P<0.05). Among symptomatic patients, the most frequent symptoms were bloody stool for patients with left colon cancer and abdominal discomfort for patients with right colon cancer (P<0.05). The prevalence of depressed cancer was higher in older subjects as compared to younger subjects (P<0.05). The prevalence of right colon cancer tended to increase with age, although this difference did not achieve statistical significance (P>0.05). CONCLUSIONS Study results indicated an increase of colon cancer amongst younger demographics in recent years. The effectiveness of colonoscopy screening was also evident, as asymptomatic patients demonstrated frequent findings of well differentiated adenocarcinomas. Study results also suggested a need for closer examination of older patients, as right colon cancer tended to increase with age.
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Affiliation(s)
| | - Chi Wook Song
- SOK Sokpeynhan Internal Medical Network, Seoul, Korea
| | - Yun Bae Kim
- SOK Sokpeynhan Internal Medical Network, Seoul, Korea
| | - Young Sun Kim
- SOK Sokpeynhan Internal Medical Network, Seoul, Korea
| | | | - Jung Hyun Lee
- SOK Sokpeynhan Internal Medical Network, Busan, Korea
| | - Won Jong Seol
- SOK Sokpeynhan Internal Medical Network, Incheon, Korea
| | - Hyung Sun Yoon
- SOK Sokpeynhan Internal Medical Network, Incheon Gyeyang, Korea
| | | | - Jong Hyup Lee
- SOK Sokpeynhan Internal Medical Network, Deagu Sangin, Korea
| | | | | | - Ji Young Park
- SOK Sokpeynhan Internal Medical Network, Cheonan, Korea
| | - Byung Hun Do
- SOK Sokpeynhan Internal Medical Network, Pohang, Korea
| | | | - Sang Jeong Yoon
- SOK Sokpeynhan Internal Medical Network, Daejeon Dunsan, Korea
| | - Chan Wook Park
- SOK Sokpeynhan Internal Medical Network, Seodaejeon, Korea
| | - Su Mi Yoon
- SOK Sokpeynhan Internal Medical Network, Anyang, Korea
| | - Jong Hwan Choi
- SOK Sokpeynhan Internal Medical Network, Uijeongbu, Korea
| | - Ki Chul Shin
- SOK Sokpeynhan Internal Medical Network, Pyeongtaek, Korea
| | - Dong Hoon Ko
- SOK Sokpeynhan Internal Medical Network, Seongnam, Korea
| | - Young Jin Kim
- SOK Sokpeynhan Internal Medical Network, Ilsan, Korea
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Ciarrocchi A, Amicucci G. Sporadic carcinoma of the colon-rectum in young patients: a distinct disease? A critical review. J Gastrointest Cancer 2014; 44:264-9. [PMID: 23712253 DOI: 10.1007/s12029-013-9507-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Colon carcinoma is rare in patients under 40 years but incidence is increasing. Results regarding outcome of this age group have been controversial and difficult to interpret. Some authors have reported a worse prognosis related to advanced stage at diagnosis and cancer-aggressive behavior. We tried to assess whether sporadic colon carcinoma in young patients is a distinct disease with different etiology and how this reflects on outcome. METHODS Most relevant papers published and indexed on PubMed in the last 20 years were reviewed. Epidemiological data were retrieved from the Surveillance, Epidemiology and End Results database and discussed. DISCUSSION Stage-specific analyses adjusted for age have demonstrated that prognosis is related to tumor stage regardless of age. Advanced stage is partly due to tumor biology and to delayed diagnosis. Younger patients show a better performance status that allows aggressive multimodal treatment. CONCLUSION Colon carcinoma in young adults appears to be a distinct disease characterized by biological aggressiveness, but prognosis is not worse due to a better performance status at time of surgical intervention.
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Affiliation(s)
- Andrea Ciarrocchi
- General and Emergency Surgery, Department of Surgery, University of L'Aquila, 67100, L'Aquila, Italy.
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128
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Ahnen DJ, Wade SW, Jones WF, Sifri R, Mendoza Silveiras J, Greenamyer J, Guiffre S, Axilbund J, Spiegel A, You YN. The increasing incidence of young-onset colorectal cancer: a call to action. Mayo Clin Proc 2014; 89:216-24. [PMID: 24393412 DOI: 10.1016/j.mayocp.2013.09.006] [Citation(s) in RCA: 320] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 08/19/2013] [Accepted: 09/05/2013] [Indexed: 12/12/2022]
Abstract
In the United States, colorectal cancer (CRC) is the third most common and second most lethal cancer. More than one-tenth of CRC cases (11% of colon cancers and 18% of rectal cancers) have a young onset (ie, occurring in individuals younger than 50 years). The CRC incidence and mortality rates are decreasing among all age groups older than 50 years, yet increasing in younger individuals for whom screening use is limited and key symptoms may go unrecognized. Familial syndromes account for approximately 20% of young-onset CRCs, and the remainder are typically microsatellite stable cancers, which are more commonly diploid than similar tumors in older individuals. Young-onset CRCs are more likely to occur in the distal colon or rectum, be poorly differentiated, have mucinous and signet ring features, and present at advanced stages. Yet, stage-specific survival in patients with young-onset CRC is comparable to that of patients with later-onset cancer. Primary care physicians have an important opportunity to identify high-risk young individuals for screening and to promptly evaluate CRC symptoms. Risk modification, targeted screening, and prophylactic surgery may benefit individuals with a predisposing hereditary syndrome or condition (eg, inflammatory bowel disease) or a family history of CRC or advanced adenomatous polyps. When apparently average-risk young adults present with CRC-like symptoms (eg, unexplained persistent rectal bleeding, anemia, and abdominal pain), endoscopic work-ups can expedite diagnosis. Early screening in high-risk individuals and thorough diagnostic work-ups in symptomatic young adults may improve young-onset CRC trends.
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Affiliation(s)
- Dennis J Ahnen
- Department of Veterans Affairs, Eastern Colorado Healthcare System, and Division of Gastroenterology, University of Colorado School of Medicine, Denver.
| | - Sally W Wade
- Wade Outcomes Research and Consulting, Salt Lake City, UT
| | - Whitney F Jones
- University of Louisville School of Medicine, and Colon Cancer Prevention Project, Louisville, KY
| | - Randa Sifri
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA
| | | | | | | | - Jennifer Axilbund
- Clinical Cancer Genetics & Prevention, The Johns Hopkins Hospital, Baltimore, MD
| | | | - Y Nancy You
- University of Texas, MD Anderson Cancer Center, Houston
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129
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Fu JF, Huang YQ, Yang J, Yi CH, Chen HL, Zheng S. Clinical characteristics and prognosis of young patients with colorectal cancer in Eastern China. World J Gastroenterol 2013; 19:8078-8084. [PMID: 24307803 PMCID: PMC3848157 DOI: 10.3748/wjg.v19.i44.8078] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 09/16/2013] [Accepted: 10/22/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the clinical characteristics and prognosis of young patients with colorectal cancer patients in Eastern China.
METHODS: A total of 1335 patients with colorectal cancer treated from December 1985 to December 2005 at the Second Affiliated Hospital of Zhejiang University School of Medicine were studied retrospectively. The patients were divided into two groups, a younger group (aged ≤ 30 years) and an older group (aged > 30 years), and comparison was made in the clinical characteristics and prognosis between the two groups. Chi-square test was used for data analysis of all categorical variables, and overall survival (OS) was calculated by the Kaplan-Meier method. A multivariate analysis was performed using the Cox model.
RESULTS: There were 42 (3.1%) and 1293 (96.9%) cases in the younger group and older group, respectively. Univariate analysis showed that the 5- and 10-year OS in the younger group were 33.9% and 26.1%, respectively, and those in the older group were 60.1% and 52.2%, respectively. Younger group had poor survival (χ2 = 14.146, P = 0.000). Multivariate analysis revealed that age was not a dependent factor for prognosis (OR = 0.866, 95%CI: 0.592-1.269, P = 0.461). Stratified analysis indicated that in stage III and IV disease, the 5- and 10-year OS were 24.6% and 14.8% in the younger group, and 40.4% and 33.3% in the older group, respectively, with a significant difference between the two groups (χ2 = 5.101, P = 0.024). In the subgroup of radical surgery, the 5- and 10-year OS were 44.3% and 34.2% in the younger group, and 69.6% and 60.5% in the older group, with a difference being significant between the two groups (χ2 = 7.830, P = 0.005).
CONCLUSION: Compared with older patients, the younger patients have lower survival, especially in the subgroups of stage III and IV disease and radical surgery.
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130
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Furman WL, Tricoli JV. Important considerations in treating children, adolescents and young adults with colorectal carcinoma. COLORECTAL CANCER 2013. [DOI: 10.2217/crc.13.40] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
SUMMARY Colorectal carcinoma (CRC) in children, adolescents and young adults under 30 years of age is rare. When it occurs in these young people, is this just an ‘adult’ cancer occurring in a young patient or is it a different disease? How should these patients be managed? Here, we review what is known about the epidemiology and clinical presentation of CRC in children, adolescents and young adults, as well as the current model for CRC development to provide a framework for questioning whether CRC in these young patients is the same disease as that seen in their older adult counterparts. In addition, we will summarize the clinical options described in the peer-reviewed literature to provide a basis for management decisions of these young patients.
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Affiliation(s)
- Wayne L Furman
- Department of Oncology, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
- University of Tennessee Department of Pediatrics, TN, USA
| | - James V Tricoli
- Diagnostic Biomarkers and Technology Branch, Cancer Diagnosis Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, 9609 Medical Center Drive, 3 West, Room 526, MSC 9728, Bethesda, MD 20892, USA
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131
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Dumont SN, Chibaudel B, Bengrine-Lefèvre L, André T, de Gramont A. Adjuvant therapy in patients with stage II and III colon cancer under 70 years of age. COLORECTAL CANCER 2013. [DOI: 10.2217/crc.13.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
SUMMARY Colorectal cancer is a common malignancy and its prognosis has improved over recent decades due to sustained efforts of the scientific community. This review focuses on adjuvant therapy across the lifespan of patients under 70 years of age. Here, we discuss the standard management of patients with stage III colon cancer, consisting of fluoropyrimidines and oxaliplatin combination for 6 months. The specific issues faced by patients with stage II colon cancer, including adjuvant chemotherapy in high-risk patients, are discussed. Finally, we describe the distinctive characteristics of patients with colon cancer under 40 years of age and the prospects of adjuvant chemotherapy in patients with colon cancer.
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Affiliation(s)
- Sarah N Dumont
- Medical Oncology Department, Saint-Antoine Hospital, Assistance Publique Hôpitaux de Paris, France
- Pierre & Marie Curie University, Paris VI, Paris, France
- GERCOR (Multidisciplinary Oncology Research Group), Paris, France
| | - Benoist Chibaudel
- Medical Oncology Department, Saint-Antoine Hospital, Assistance Publique Hôpitaux de Paris, France
- Pierre & Marie Curie University, Paris VI, Paris, France
- GERCOR (Multidisciplinary Oncology Research Group), Paris, France
| | - Leïla Bengrine-Lefèvre
- Medical Oncology Department, Saint-Antoine Hospital, Assistance Publique Hôpitaux de Paris, France
- Pierre & Marie Curie University, Paris VI, Paris, France
- GERCOR (Multidisciplinary Oncology Research Group), Paris, France
| | - Thierry André
- Medical Oncology Department, Saint-Antoine Hospital, Assistance Publique Hôpitaux de Paris, France
- Pierre & Marie Curie University, Paris VI, Paris, France
- GERCOR (Multidisciplinary Oncology Research Group), Paris, France
| | - Aimery de Gramont
- Pierre & Marie Curie University, Paris VI, Paris, France
- GERCOR (Multidisciplinary Oncology Research Group), Paris, France
- Medical Oncology Department, Saint-Antoine Hospital, Assistance Publique Hôpitaux de Paris, France.
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132
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Young colorectal carcinoma patients do not have a poorer prognosis: a comparative review of 2,426 cases. Tech Coloproctol 2013; 17:653-61. [PMID: 23460362 DOI: 10.1007/s10151-013-0977-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 01/16/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) in "young" patients under 50 years of age is uncommon. There have been conflicting reports regarding both the clinicopathological features of CRC in young patients and prognosis. The aim of this study was to review and compare the clinical characteristics, prognostic factors, and overall survival of patients in three different age groups (40 years and under, 41-50 years, over 50 years of age) and the prognosis of these patients. METHODS A total of 2,426 consecutive patients who had undergone surgical resection for sporadic colorectal cancer at Singapore General Hospital in the period from 2000 to 2005 were retrieved from a prospectively collected computer database. There were 73 patients (3.0 %) in Group 1 (40 years old or less), 257 (10.6 %) in Group 2 (41-50 years old), and 2,096 (86.4 %) in Group 3 (>50 years old). Clinicopathological features were assessed using univariate analysis to evaluate significant differences, survival curves were constructed using the Kaplan-Meier method, and multivariate analysis was performed to evaluate the independent prognostic factors. RESULTS Young CRC patients tend to present with a higher incidence of mucinous and signet ring cell tumors (Group 1-20.5 %, Group 2-8.2 %, Group 3-6.2 %, p < 0.001) and have more poorly differentiated tumors (Group 1-20.0 %, Group 2-9.7 %, Group 3-7.4 %, p = 0.014). Furthermore, young CRC patients tend to present with regional lymph node metastases (Group 1-65.7 %, Group 2-60.8 %, Group 3-51.0 %, p = 0.001) and distant metastases (Group 1-31.5 %, Group 2-24.1 %, Group 3-19.4 %, p = 0.006). Multivariate analysis reveals, however, that young age is not an independent prognostic factor for cancer-specific survival (CSS) (p = 0.392). Five-year CSS for Group 1 was 56.6 % (95 % confidence interval (CI) 44.8-68.4 %), Group 2 53.8 % (95 % CI 47.3-60.3 %), and Group 3 61.1 % (95 % CI 58.9-63.3 %). CONCLUSIONS Although presenting with advanced tumors and with poorer prognostic factors such as presence of mucin and poor histological differentiation, young CRC patients do not have a worse prognosis.
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133
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Wallace K, Hill EG, Lewin DN, Williamson G, Oppenheimer S, Ford ME, Wargovich MJ, Berger FG, Bolick SW, Thomas MB, Alberg AJ. Racial disparities in advanced-stage colorectal cancer survival. Cancer Causes Control 2013; 24:463-71. [PMID: 23296454 DOI: 10.1007/s10552-012-0133-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 12/17/2012] [Indexed: 12/11/2022]
Abstract
PURPOSE African-Americans (AA) have a higher incidence of and lower survival from colorectal cancer (CRC) compared with European Americans (EA). In the present study, statewide, population-based data from South Carolina Central Cancer Registry are used to investigate the relationship between race and age on advanced-stage CRC survival. METHODS The study population was comprised of 3,865 advanced pathologically documented colon and rectal adenocarcinoma cases diagnosed between 01 January 1996 and 31 December 2006: 2,673 (69 %) EA and 1,192 (31 %) AA. Kaplan-Meier methods were used to generate median survival time and corresponding 95 % confidence intervals (CI) by race, age, and gender. Factors associated with survival were evaluated by fitting Cox proportional hazards regression models to generate hazard ratios (HR) and 95 % CI. RESULTS We observed a significant interaction between race and age on CRC survival (p = 0.04). Among younger patients (<50 years), AA race was associated with a 1.34 times (95 % CI 1.06-1.71) higher risk of death compared with EA. Among older patients, we observed a modest increase in risk of death among AA men compared with EA [HR 1.16 (95 % CI 1.01-1.32)] but no difference by race between women [HR 0.94 (95 % CI 0.82-1.08)]. Moreover, we observed that the disparity in survival has worsened over the past 15 years. CONCLUSIONS Future studies that integrate clinical, molecular, and treatment-related data are needed for advancing understanding of the racial disparity in CRC survival, especially for those <50 years old.
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Affiliation(s)
- Kristin Wallace
- Division of Epidemiology and Biostatistics, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
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134
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Kenney B, Deng Y, Mitchell K. Expression of p27, COX-2, MLH1, and MSH2 in young patients with colon carcinoma and correlation with morphologic findings. Hum Pathol 2012; 44:591-7. [PMID: 23084580 DOI: 10.1016/j.humpath.2012.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 07/01/2012] [Accepted: 07/05/2012] [Indexed: 11/24/2022]
Abstract
Despite an overall decrease in colorectal carcinoma incidence, rates of colorectal carcinoma have increased substantially in patients aged less than 40 years. Several authors have characterized morphologic features of colorectal carcinoma in young patients, with variable results. To date, there has been 1 detailed molecular and immunohistochemical study in young patients with colorectal carcinoma. We sought to expand the data regarding young patients with colorectal carcinoma by a detailed assessment of morphologic features and by assaying expression of p27, COX-2, MLH1, and MSH2, markers with prognostic or therapeutic implications in colorectal carcinoma. We searched our pathology database from 1985 to 2009 and, after exclusion of cases with insufficient data or neoadjuvant therapy, identified a study population of 23 patients aged 40 or younger, 35 patients between 41 and 49 years of age, and a control group of 83 colorectal carcinoma patients aged 50 or older. Younger patients had higher tumor grade (P = .0085), with a trend toward mucinous differentiation and lymphovascular and perineural invasion. Loss of MSH2 was more prominent in younger patients (P = .02). Loss of p27 expression was not associated with age, but was associated with higher tumor stage (P = .0278), mucinous/signet ring differentiation (P = .0185), loss of either MLH1 or MSH2 (P = .0035), and larger tumor size (P = .0019). There was a trend toward lower COX-2 expression in younger patients, with less COX-2 expression relative to previously published data. Our findings support some prior reports regarding morphologic features in colorectal carcinoma in young patients and provide novel data on expression of several markers in this population.
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Affiliation(s)
- Barton Kenney
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06510, USA.
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135
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Chang DT, Pai RK, Rybicki LA, Dimaio MA, Limaye M, Jayachandran P, Koong AC, Kunz PA, Fisher GA, Ford JM, Welton M, Shelton A, Ma L, Arber DA, Pai RK. Clinicopathologic and molecular features of sporadic early-onset colorectal adenocarcinoma: an adenocarcinoma with frequent signet ring cell differentiation, rectal and sigmoid involvement, and adverse morphologic features. Mod Pathol 2012; 25:1128-39. [PMID: 22481281 DOI: 10.1038/modpathol.2012.61] [Citation(s) in RCA: 227] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Recent literature suggests an increasing incidence of colorectal carcinoma in young patients. We performed a histologic, molecular, and immunophenotypic analysis of patients with sporadic early-onset (≤40 years of age) colorectal carcinoma seen at our institution from the years 2000-2010 and compared these tumors to a cohort of consecutively resected colorectal carcinomas seen in patients >40 years of age. A total of 1160 primary colorectal adenocarcinomas were surgically resected for the years 2000 through 2010. Of these, 75 (6%) were diagnoses in patients ≤40 years of age of which 13 (17%) demonstrated abnormalities in DNA mismatch repair, 4 (5%) were in patients with known germline genetic disorders (two patients with familial adenomatous polyposis, one patient with juvenile polyposis, and one patient with Li-Fraumeni syndrome), and three patients (4%) had long-standing chronic inflammatory bowel disease. The sporadic early-onset colorectal carcinoma group comprised a total of 55 patients (55/1160, 5%) and were compared with a control group comprising 73 consecutively resected colorectal carcinomas with proficient DNA mismatch repair in patients >40 years of age. For the early-onset colorectal carcinoma group, most cases (33/55, 60%) were diagnosed between the age of 35 and 40 years of age. Compared with the control group, the early-onset colorectal carcinoma group was significantly different with respect to tumor location (P<0.007) with 80% (44/55 cases) identified in either the sigmoid colon (24/55, 44%) or rectum (20/55, 36%). Morphologically, early-onset colorectal carcinomas more frequently displayed adverse histologic features compared with the control colorectal carcinoma group such as signet ring cell differentiation (7/55, 13% vs 1/73, 1%, P=0.021), perineural invasion (16/55, 29% vs 8/73, 11%, P=0.009) and venous invasion (12/55, 22% vs 4/73, 6%, P=0.006). A precursor adenomatous lesion was less frequently identified in the early-onset colorectal carcinoma group compared with the control group (19/55, 35% vs 39/73, 53%, P=0.034). Of the early-onset colorectal carcinomas, only 2/45 cases (4%) demonstrated KRAS mutations compared with 11/73 (15%) of the control group colorectal adenocarcinomas harboring KRAS mutations, although this difference did not reach statistical significance (P=0.13). BRAF V600E mutations were not identified in the early-onset colorectal carcinoma group. No difference was identified between the two groups with regard to tumor stage, tumor size, number of lymph node metastases, lymphatic invasion, tumor budding, mucinous histology, or tumor-infiltrating lymphocytes. Both groups had similar recurrence-free (P=0.28) and overall survival (P=0.73). However, patients in the early-onset colorectal carcinoma group more frequently either presented with or developed metastatic disease during their disease course compared with the control colorectal carcinoma group (25/55, 45% vs 18/73, 25%, P=0.014). In addition, 8/55 patients (15%) in the early-onset colorectal carcinoma group developed local recurrence of their tumor while no patients in the control colorectal carcinoma group developed local recurrence (P<0.001), likely due to the increased incidence of rectal carcinoma in the patients with early-onset colorectal carcinoma. Our study demonstrates that colorectal carcinoma is not infrequently diagnosed in patients ≤40 years of age and is not frequently the result of underlying Lynch syndrome or associated with other cancer-predisposing genetic conditions or chronic inflammatory conditions. These tumors have a striking predilection for the distal colon, particularly the sigmoid colon and rectum and are much more likely to demonstrate adverse histologic factors, including signet ring cell differentiation, venous invasion, and perineural invasion.
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MESH Headings
- Adenocarcinoma/epidemiology
- Adenocarcinoma/genetics
- Adenocarcinoma/metabolism
- Adenocarcinoma/pathology
- Adenoma/epidemiology
- Adenoma/genetics
- Adenoma/metabolism
- Adenoma/pathology
- Adolescent
- Adult
- Age of Onset
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- California/epidemiology
- Carcinoma, Signet Ring Cell/epidemiology
- Carcinoma, Signet Ring Cell/genetics
- Carcinoma, Signet Ring Cell/metabolism
- Carcinoma, Signet Ring Cell/pathology
- Colon, Sigmoid/metabolism
- Colon, Sigmoid/pathology
- Colon, Sigmoid/surgery
- Colorectal Neoplasms/epidemiology
- Colorectal Neoplasms/genetics
- Colorectal Neoplasms/metabolism
- Colorectal Neoplasms/pathology
- DNA Mismatch Repair
- DNA-Binding Proteins/genetics
- DNA-Binding Proteins/metabolism
- Female
- Humans
- Male
- Microsatellite Instability
- Middle Aged
- MutS Homolog 3 Protein
- Mutation
- Proto-Oncogene Proteins/genetics
- Proto-Oncogene Proteins B-raf/genetics
- Proto-Oncogene Proteins p21(ras)
- Rectum/metabolism
- Rectum/pathology
- Rectum/surgery
- Young Adult
- ras Proteins/genetics
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Affiliation(s)
- Daniel T Chang
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
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Youn P, Li H, Milano MT, Stovall M, Constine LS, Travis LB. Long-term survival among Hodgkin's lymphoma patients with gastrointestinal cancer: a population-based study. Ann Oncol 2012; 24:202-8. [PMID: 22855552 DOI: 10.1093/annonc/mds218] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The increased risk of gastrointestinal (GI) cancers after Hodgkin's lymphoma (HL) is well established. However, no large population-based study has described the actuarial survival after subsequent GI cancers in HL survivors (HL-GI). PATIENTS AND METHODS For 209 patients with HL-GI cancers (105 colon, 35 stomach, 30 pancreas, 21 rectum, and 18 esophagus) and 484 165 patients with first primary GI cancers (GI-1), actuarial survival was compared, accounting for age, gender, race, GI cancer stage, radiation for HL, and other variables. RESULTS Though survival of HL patients who developed localized stage colon cancer was similar to that of the GI-1 group, overall survival (OS) of HL patients with regional or distant stage colon cancer was reduced [hazard ratio, (HR)=1.46, P=0.01]. The HL survivors with regional or distant stage colon cancer in the transverse segment had an especially high risk of mortality (HR: 2.7, P=0.001 for OS). For localized stomach cancer, OS was inferior among HL survivors (HR=3.46, P=0.006). CONCLUSIONS The HL patients who develop GI cancer experience significantly reduced survival compared with patients with a first primary GI cancer. Further research is needed to explain the inferior survival of HL patients and to define selection criteria for cancer screening in HL survivors.
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Affiliation(s)
- P Youn
- Department of Radiation Oncology and Rubin Center for Cancer Survivorship, University of Rochester Medical Center, Rochester, NY 14642, USA
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Creagh TA, Dixon L, Frizelle FA. Reconstruction with Vertical Rectus Abdominus Myocutaneous flap in advanced pelvic malignancy. J Plast Reconstr Aesthet Surg 2012; 65:791-7. [DOI: 10.1016/j.bjps.2011.11.063] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 09/15/2011] [Accepted: 11/10/2011] [Indexed: 01/06/2023]
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Hubbard J, Thomas DM, Yothers G, Green E, Blanke C, O'Connell MJ, Labianca R, Shi Q, Bleyer A, de Gramont A, Sargent D. Benefits and adverse events in younger versus older patients receiving adjuvant chemotherapy for colon cancer: findings from the Adjuvant Colon Cancer Endpoints data set. J Clin Oncol 2012; 30:2334-9. [PMID: 22614981 DOI: 10.1200/jco.2011.41.1975] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Limited data exist regarding the outcomes of adjuvant therapy in younger patients with stage II and III colon cancer. We examined disease-free survival (DFS), overall survival (OS), recurrence-free interval (RFI), and grade 3+ adverse events (AEs) in younger patients in the 33,574 patient Adjuvant Colon Cancer Endpoints Group data set. PATIENTS AND METHODS Individual patient data from 24 randomized phase III clinical trials were obtained for survival outcomes, which included 10 clinical trials for AE outcomes. Two age-based cutoff points were used to define younger patients: age younger than 40 years and younger than 50 years. Adjuvant therapy benefit analyses were limited to the nine clinical trials in which the investigational chemotherapeutic arm demonstrated benefit. RESULTS One thousand seven hundred fifty-eight patients (5.2%) were younger than 40 years, 5,817 patients (17.3%) were younger than 50 years, and only 299 patients (0.9%) were younger than 30 years. No meaningful differences in sex or stage were noted in younger versus older patients. Younger and older patients did not differ in RFI (age, < 40 years: hazard ratio [HR], 1.0; P = .62 and age < 50 years: HR, 1.02; P = .35). Younger patients (both cutoff points), had longer OS and DFS than older patients. In trials demonstrating adjuvant therapy benefit, similar DFS benefit was observed by age. Younger patients experienced less leukopenia and stomatitis, but more frequent nausea/vomiting. CONCLUSION Among patients on clinical trials, younger and older patients with stage II and III colon cancer had similar RFI and adjuvant therapy benefit. Younger patients have longer OS and DFS, which is likely primarily because of fewer competing causes of death. Adjuvant therapy is beneficial for colon cancer in patients younger than 50 years who meet typical clinical trial eligibility criteria.
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McCulloch M, Broffman M, van der Laan M, Hubbard A, Kushi L, Abrams DI, Gao J, Colford JM. Colon cancer survival with herbal medicine and vitamins combined with standard therapy in a whole-systems approach: ten-year follow-up data analyzed with marginal structural models and propensity score methods. Integr Cancer Ther 2011; 10:240-59. [PMID: 21964510 DOI: 10.1177/1534735411406539] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Although localized colon cancer is often successfully treated with surgery, advanced disease requires aggressive systemic therapy that has lower effectiveness. Approximately 30% to 75% of patients with colon cancer use complementary and alternative medicine (CAM), but there is limited formal evidence of survival efficacy. In a consecutive case series with 10-year follow-up of all colon cancer patients (n = 193) presenting at a San Francisco Bay-Area center for Chinese medicine (Pine Street Clinic, San Anselmo, CA), the authors compared survival in patients choosing short-term treatment lasting the duration of chemotherapy/radiotherapy with those continuing long-term. To put these data into the context of treatment responses seen in conventional medical practice, they also compared survival with Pan-Asian medicine + vitamins (PAM+V) with that of concurrent external controls from Kaiser Permanente Northern California and California Cancer Registries. Kaplan-Meier, traditional Cox regression, and more modern methods were used for causal inference-namely, propensity score and marginal structural models (MSMs), which have not been used before in studies of cancer survival and Chinese herbal medicine. PAM+V combined with conventional therapy, compared with conventional therapy alone, reduced the risk of death in stage I by 95%, stage II by 64%, stage III by 29%, and stage IV by 75%. There was no significant difference between short-term and long-term PAM+V. Combining PAM+V with conventional therapy improved survival, compared with conventional therapy alone, suggesting that prospective trials combining PAM+V with conventional therapy are justified.
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Chou CL, Chang SC, Lin TC, Chen WS, Jiang JK, Wang HS, Yang SH, Liang WY, Lin JK. Differences in clinicopathological characteristics of colorectal cancer between younger and elderly patients: an analysis of 322 patients from a single institution. Am J Surg 2011; 202:574-82. [PMID: 21872205 DOI: 10.1016/j.amjsurg.2010.10.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 10/06/2010] [Accepted: 10/06/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND The prognosis of patients with colorectal cancer (CRC) of different onset ages is controversial. METHODS Data were obtained from a prospective database at Taipei Veterans General Hospital. There were 2,738 newly diagnosed patients with CRC from 2001 to 2006. Two extreme age groups, younger (≤40 years) and elderly (≥80 years), were analyzed to compare clinicopathologic characteristics and prognosis after exclusion of specific cancer syndrome. RESULTS A total of 322 patients were enrolled in this prospective study. The younger group consisted of 69 patients with mean age of 33.5 years, and the elderly group consisted of 253 patients with mean age of 83.4 years. Younger patients had a higher incidence of mucinous cell type (14.5% vs 6.3%, P = .05), poorly differentiated adenocarcinoma (26.1% vs 6.3%, P < .001), more advanced disease (82.6% vs 41.9%, P < .001), poorer disease-free survival (67.2% vs 79.3%, P = .048), and cancer-specific survival (44.1% vs 73.1%, P < .001) than elderly patients. CONCLUSIONS In patients with CRC of younger onset, without relevant predisposing risk factors, younger patients have more advanced stages of disease, more aggressive histopathologic characteristics, and poorer prognoses compared with older patients.
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Affiliation(s)
- Chia-Lin Chou
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
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Blanke CD, Bot BM, Thomas DM, Bleyer A, Kohne CH, Seymour MT, de Gramont A, Goldberg RM, Sargent DJ. Impact of young age on treatment efficacy and safety in advanced colorectal cancer: a pooled analysis of patients from nine first-line phase III chemotherapy trials. J Clin Oncol 2011; 29:2781-6. [PMID: 21646604 PMCID: PMC4874194 DOI: 10.1200/jco.2010.33.5281] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 04/13/2011] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Colorectal cancer predominantly occurs in the elderly, but approximately 5% of patients are 50 years old or younger. We sought to determine whether young age is prognostic, or whether it influences efficacy/toxicity of chemotherapy, in patients with advanced disease. METHODS We analyzed individual data on 6,284 patients from nine phase III trials of advanced colorectal cancer (aCRC) that used fluorouracil-based single-agent and combination chemotherapy. End points included progression-free survival (PFS), overall survival (OS), response rate (RR), and grade 3 or worse adverse events. Stratified Cox and adjusted logistic-regression models were used to test for age effects and age-treatment interactions. RESULTS A total of 793 patients (13%) were younger than 50 years old; 188 of these patients (3% of total patients) were younger than 40 years old. Grade 3 or worse nausea (10% v 7%; P = .01) was more common, and severe diarrhea (11% v 14%; P = .001) and neutropenia (23% v 26%; P < .001) were less common in young (younger than 50 years) than in older (older than 50 years) patients. Age was prognostic for PFS, with poorer outcomes occurring in those younger than 50 years (median, 6.0 v 7.5 months; hazard ratio, 1.10; P = .02), but it did not affect RR or OS. In the subset of monotherapy versus combination chemotherapy trials, the relative benefits of multiagent chemotherapy were similar for young and older patients. Results were comparable when utilizing an age cut point of 40 years. CONCLUSION Young age is modestly associated with poorer PFS but not OS or RR in treated patients with aCRC, and young patients have more nausea but less diarrhea and neutropenia with chemotherapy in general. Young versus older patients derive the same benefits from combination chemotherapy. Absent results of a clinical trial, standard combination chemotherapy approaches are appropriate for young patients with aCRC.
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Affiliation(s)
- Charles D Blanke
- University of British Columbia and British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
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Davis DM, Marcet JE, Frattini JC, Prather AD, Mateka JJL, Nfonsam VN. Is it time to lower the recommended screening age for colorectal cancer? J Am Coll Surg 2011; 213:352-61. [PMID: 21737316 DOI: 10.1016/j.jamcollsurg.2011.04.033] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 03/29/2011] [Accepted: 04/19/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND Overall, colorectal cancer (CRC) incidence in the US has decreased over the last 30 years, yet it has increased in patients younger than 50. Cancers in this population are more aggressive and advanced at diagnosis. Our goal was to determine if screening should begin at a younger age. To accomplish this, we analyzed the rates of change in CRC incidence, and compared the incidence with that of cervical cancer (CC), which is screened earlier. Locations of CRC were compared to determine the appropriate screening method. STUDY DESIGN Incidence statistics were obtained from the Cancer Query System of the SEER database. Data were obtained from 1987 to 2006 in age groups of 5-year increments from 0 to 4 years old to 85+ years old for incidences of colon, rectal, and overall CRC. Combined data from 2002 to 2006 were queried to determine the locations of tumors and the overall incidence of CRC and CC at different ages. RESULTS Across age groups 20 to 49, CRC incidence was higher in 2006 than in 1987. The most significant increase was from age 40 to 44, where CRC increased from a low of 10.7 per 100,000 in 1988 to 17.9 per 100,000 in 2006 (67%). Colon and rectal cancer increased 56% and 94%, respectively. People older than 50 had decreasing incidences. Approximately 30% of cancers in patients aged 35 to 49 occurred proximal to the splenic flexure. The incidence of CRC cancer equaled and subsequently surpassed CC in the 40 to 44 age group. CONCLUSIONS The most significant increase in CRC has occurred in patients ages 40 to 44. Patients over 50 continued to see a decline. Many of these cancers would be missed with sigmoidoscopy. Consideration should be given for age-based colonoscopic screening beginning at age 40, an age at which the incidence mirrors other accepted screened cancers.
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Affiliation(s)
- Donald M Davis
- Department of Surgery, University of South Florida College of Medicine, Tampa, FL, USA.
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Ganapathi S, Kumar D, Katsoulas N, Melville D, Hodgson S, Finlayson C, Hagger R. Colorectal cancer in the young: trends, characteristics and outcome. Int J Colorectal Dis 2011; 26:927-34. [PMID: 21424713 DOI: 10.1007/s00384-011-1174-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) in young patients is associated with a poor outcome due to advanced stage at diagnosis and poor differentiation. AIM The aim of this study is to compare clinicopathological characteristics, overall survival (OS) and disease-free survival (DFS) of young (≤40 years) and older patients with CRC. METHODS A total of 2,538 patients including 59 young patients (age ≤40 years) with CRC were identified over 20 years. The clinicopathological variables of young patients were compared with a group of consecutive older patients (n = 416) spanning both decades. Survival analysis was done using Kaplan-Meier, log-rank and Cox regression models. RESULTS The frequency in young patients increased from 1.4% to 3.0% from first to second decade (overall -2.3%, p = 0.006). There was a higher frequency of tumours with poor differentiation (43% vs. 16%, p = < 0.001), T4 stage (47% vs. 30%, p = 0.005) and vascular invasion (VI; 38% vs. 29%, p = 0.13) in younger group. There was no significant difference in OS (p = 0.116) and DFS (p = 0.261) between the two groups. Node-negative young patients had a significantly better OS (p = 0.046). Young patients with VI had significantly reduced OS (p = 0.043), whereas young patients without VI had significantly better OS (p = 0.012). Multivariate analysis showed T4 status (p = 0.001) and vascular invasion (p = 0.002) as independent prognostic factors for OS and T4 status (p = 0.004) as independent factor influencing DFS. CONCLUSION The frequency of CRC in young patients increased significantly. Vascular invasion is the single most important prognostic factor in young CRC. Along with vascular invasion, high proportion of T4 status in young patients increases the chances of recurrence and negates any survival advantage in young patients.
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Affiliation(s)
- Senthil Ganapathi
- Department of Colorectal Surgery, St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK
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The average-risk age threshold for colorectal cancer screening: should it be lowered? Dig Dis Sci 2011; 56:1249-51. [PMID: 21360278 DOI: 10.1007/s10620-011-1650-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Abstract
PURPOSE This study was designed to characterize the entity of colorectal cancer (CRC) in young patients and to evaluate whether it has any unique epidemiological or clinicopathological features. METHODS The study population consisted of all consecutive young (≤50 years old at diagnosis) patients with CRC who were diagnosed during the years 1997-2007 and were treated at our institution, and a matching group of patients (>50 years at diagnosis). The medical files of these patients were reviewed, and the epidemiological, clinical, and pathological features of both groups were compared. RESULTS There were 406 patients: 203 in each group. The features of the older group were typical for patients with CRC, but the younger group showed female predominance, different ethnic composition, prevalence of family history of cancer and hereditary CRC syndromes, and lower incidence of polyps. The incidence of left-sided tumors and advanced stages (III-IV) at diagnosis was higher in the younger patients. Mucinous/signet ring histology, grade, stage, lymphatic and vascular invasion were all predictive of survival, whereas age was not. CONCLUSIONS Colorectal cancer in young patients was found to display a cluster of unique characteristics but fewer than previously reported and young age by itself was not found to impact patient outcome.
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Hemminki K, Santi I, Weires M, Thomsen H, Sundquist J, Bermejo JL. Tumor location and patient characteristics of colon and rectal adenocarcinomas in relation to survival and TNM classes. BMC Cancer 2010; 10:688. [PMID: 21176147 PMCID: PMC3022888 DOI: 10.1186/1471-2407-10-688] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 12/21/2010] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Old 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. METHODS The 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. RESULTS The 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. CONCLUSIONS The 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.
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Affiliation(s)
- Kari Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Irene Santi
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany
| | - Marianne Weires
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany
| | - Hauke Thomsen
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California, USA
| | - Justo Lorenzo Bermejo
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany
- Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, Germany
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Snaebjornsson P, Jonasson L, Jonsson T, Möller PH, Theodors A, Jonasson JG. Colon cancer in Iceland--a nationwide comparative study on various pathology parameters with respect to right and left tumor location and patients age. Int J Cancer 2010; 127:2645-53. [PMID: 20162576 DOI: 10.1002/ijc.25258] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Increasing evidence suggests genetic, biological and demographical difference between right and left colon cancer. Studies have also indicated age differences in the pathology of colon cancer. There is a scarcity of large-scale studies that closely examine the pathological differences regarding age and tumor location. The aim of our study was to do an extensive comparison of right- and left- sided colon cancers as well as comparing patients <50 years with older patients. A retrospective, population-based study was carried out on all patients with colon cancer in Iceland between 1955 and 2004. A total of 2293 cases were analyzed (1148 men, 1145 women). All histopathology material was re-evaluated. Differences in tumor characteristics between right and left location and younger (<50) and older (≥50) patients was evaluated in particular. Higher TNM-stage, larger tumors, vessel invasion, mucinous type, high grade and expanding tumor border occurred more frequently in right- versus left-sided lesions while annular and polypoid tumors were more common in left-sided tumors (p < 0.05). Young patients had more frequent lymph node metastases, vessel invasion, nonpolypoid lesions and infiltrating tumor border (p < 0.05). Right-sided lesions show more aggressive features, reflected in morphology and stage. Younger patients present more frequently with adverse features than do older patients. Frequency of right- and left-sided colon cancer differs by age with pronounced age-location differences in females. This supports the assumption of differences in etiology and carcinogenesis of right- and left-sided colon cancer, and between young and old patients.
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How to Manage the Patient with Early-Age-of-Onset (<50 years) Colorectal Cancer? Surg Oncol Clin N Am 2010; 19:725-31. [DOI: 10.1016/j.soc.2010.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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149
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Is gender related to the stage of colorectal cancer at initial presentation in young patients? J Surg Res 2010; 165:15-8. [PMID: 21074787 DOI: 10.1016/j.jss.2010.08.054] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Revised: 08/16/2010] [Accepted: 08/27/2010] [Indexed: 01/11/2023]
Abstract
BACKGROUND The incidence of colorectal cancer (CRC) in young adults is rising, and young age is a predictor of poor survival. The purpose of this study was to examine factors leading to increased mortality in patients ≤ 50 years of age, and to examine this population for characteristics that could lead to benefit from CRC screening. METHODS Charts of patients 50 years of age and under, diagnosed with CRC from 1998 through 2007, at our community teaching hospital, were reviewed retrospectively. Demographics, social and family history, staging, treatment and death were evaluated. Mann Whitney, Fisher Exact, and χ(2) tests were used with P <0.05 considered statistically significant. RESULTS Forty-five young patients with CRC were identified. Twenty-five patients were female and 20 male; the mean age was 43.6 y. Most patients presented with rectal bleeding. Right-sided cancers had a higher presenting stage (P < 0.05). Men had both a higher presenting stage (P = 0.35) and a higher incidence of smoking compared with women (P = 0.001). Female patients were more likely to have left-sided CRC (65%) compared with men (35%). Ninety-six percent of patients underwent surgical resection; 14 patients died. CONCLUSIONS CRC in young adults is not common, but is often advanced when discovered. Diagnostic efforts should be aggressive in young patients who have rectal bleeding, especially young male smokers. Sigmoidoscopy is not adequate for comprehensive diagnosis of CRC in young patients, as the majority have right-sided colon cancers, which often result in subsequent presentation of the disease at a higher stage, risk, and mortality rate.
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Chan KK, Dassanayake B, Deen R, Wickramarachchi RE, Kumarage SK, Samita S, Deen KI. 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. World J Surg Oncol 2010; 8:82. [PMID: 20840793 PMCID: PMC2954852 DOI: 10.1186/1477-7819-8-82] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 09/15/2010] [Indexed: 12/14/2022] Open
Abstract
Objectives This 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 methods A 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. Results Young 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. Conclusion If patients, who are less than 40 years old with colorectal cancer, survive twenty months after operation, the prognosis improves and their survival becomes predictable.
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Affiliation(s)
- K K Chan
- The Johor Bahru Hospital, Johor, Malaysia
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