Differences in clinicopathological characteristics of colorectal cancer between younger and elderly patients: an analysis of 322 patients from a single institution
ABSTRACT The prognosis of patients with colorectal cancer (CRC) of different onset ages is controversial.
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.
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.
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.
Internal and Emergency Medicine 07/2014; 9(6). DOI:10.1007/s11739-014-1101-8 · 2.41 Impact Factor
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ABSTRACT: Inferior outcomes in younger patients with colorectal cancer may be associated with multiple factors, including tumor biology, delayed diagnosis, disparities such as access to care, and/or treatment differences. This study aims to examine age-based colorectal cancer outcomes in an equal-access health care system. This study is a retrospective large multi-institutional database analysis. Patients with colorectal cancer included in the Department of Defense Automated Central Tumor Registry (January 1993 to December 2008) were stratified by age <40, 40 to 49, 50 to 79, and ≥80 years to determine the effect of age on incidence, treatment, and outcomes. The primary outcomes measured were the stage at presentation, adjuvant therapy use, 3- and 5-year disease-free survival, and overall survival. Some 7948 patients were identified; most (77%) patients were in the 50- to 79-year age group. Overall, 25% presented with stage III disease. Compared with patients aged 50 to 79 and ≥80 years, patients aged <40 and 40 to 49 years presented more frequently with advanced disease (stage III (35% and 35% vs 28% and 26%) and stage IV (24% and 21% vs 18% and 15%); all p < 0.001). Adjuvant chemotherapy use in stage III patients was 62%; those patients ≥80 and 50 to 79 years had decreased use (p < 0.001). Overall recurrence was 8.1% at 3 years and 9.7% at 5 years, with the highest rates in patients <40 years (11.8%; p = 0.007). Overall survival was worse in patients ≥80 years, whereas the remaining cohorts were similar. For stage III disease, patients 40 to 49 years had the highest survival among all cohorts (p < 0.001). This study was limited by the lack of specific comorbid information and the limitations inherent to large database reviews. In an equal-access system, young age at presentation (<50 years) was associated with advanced stage and higher recurrence of colorectal cancer, but similar survival in comparison with older patients. Although increased adjuvant therapy use in younger patients may partially account for stage-specific increases in survival, the relative decreased chemotherapy use overall requires further evaluation.Diseases of the Colon & Rectum 03/2014; 57(3):303-10. DOI:10.1097/DCR.0b013e3182a586e7 · 3.20 Impact Factor
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ABSTRACT: BackgroundThe incidence of colorectal cancer rises disproportionally in aging persons. With a shift towards higher population age in general, an increasing number of older patients require adequate treatment. This study aims to investigate differences between young and elderly patients who undergo resection for colorectal cancer, regarding clinical characteristics, morbidity, and prognosis.MethodsBy retrospective analysis of 6 years (2007 to 2012) of a prospectively documented database, a total of 636 patients were identified who underwent oncological resection for colorectal cancer at our institution. Of this total, all 569 patients with primary colorectal adenocarcinoma were included. Four hundred ten patients were 74 years or younger and 159 were 75 years or older. The median follow-up was 22 months.ResultsOlder patients had significantly more comorbidities (85 % vs. 56 %, p < 0.001) and a higher ASA score (p < 0.001). The mean length of stay in the hospital was longer (24 vs. 20 days, p = 0.002), as was the length of postoperative intensive care stay (4 vs. 2 days, p = 0.003). However, elderly patients did not have significantly higher rates of intraoperative complications or surgical morbidity. Tumor-specific 2-year survival was 83 ± 4 % for the elderly and 87 ± 2 % for the younger patients, which was not significantly different (p = 0.90).ConclusionsLong-term outcome after oncologic resection for colorectal cancer does not differ between elderly and younger patients. Age in general should not be considered as a limiting factor for colorectal cancer surgery or tumor-specific prognosis.International Journal of Colorectal Disease 06/2014; 29(8). DOI:10.1007/s00384-014-1914-y · 2.42 Impact Factor