Colon cancer relapse, death more common among children, young adults
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Individuals aged 25 years and younger with colon cancer appeared to be at higher risk for relapse and death than older adults, according to data published in Journal of the American College of Surgeons.
“During my pediatric surgical oncology fellowship at [The University of Texas] MD Anderson Cancer Center, it was anecdotally noticed that young patients presenting with colorectal cancer did not do well. It had been well-documented that young patients often present late because colorectal cancer is not considered in the young,” Gideon Sandler, BSc (Med), MBBS (Hons I), MS, DCH, FRACS, surgical oncologist at Westmead Hospital and The Children’s Hospital at Westmead in Sydney, told Healio. “Given these patients did so poorly overall, we wanted to explore if that was a function of their late presentation only or if there was another host- or disease-related variable. We, therefore, compared populations stage-for-stage, based on age.”
The analysis included 94 patients aged 25 years and younger (median age at diagnosis, 21 years; range, 10-25; 52.4% male) treated for colon cancer at MD Anderson between 1991 and 2017, as well as 765 adults aged older than 25 years treated for colon cancer and included in a prospectively maintained database.
The researchers used the Kaplan-Meier method to estimate OS and RFS. They compared outcomes using multivariable Cox models and the log rank test.
Of the 80 patients aged 25 years and younger who were evaluable for OS, 49 died.
Sandler and colleagues reported 3-year OS rates of 41.9% (95% CI, 31.9-79.6) for younger patients vs. 90% (95% CI, 87-92) for patients aged older than 25 years (P < .0001). RFS was 32% for younger patients vs. 78% for older patients (P < .0001).
A stage-by-stage comparison of 5-year OS for younger vs. older patients showed rates of 100% vs. 96% for stage I disease, 64% vs. 90% (P < .0001) for stage II disease, 58% vs. 85% (P < .0001) for stage III disease and 16% vs. 55% (P < .0001) for stage IV disease.
Stage-for-stage 5-year RFS rates were 100% vs. 95% for stage I disease, 55% vs. 85% (P = .0002) for stage II disease, 31% vs. 73% (P < .0001) for stage III disease and 5% vs. 27% (P < .0001) for stage IV disease.
Results of a multivariate analysis showed younger patients had a significantly higher risk for recurrence or death than older patients (HR = 2.31; 95% CI, 1.61-3.31). In addition, researchers observed significantly increased incidence of peritoneal metastasis among younger patients (P = .00001). They noted that 71.3% of patients had no defined predisposing syndrome.
“We next plan to explore some of the reasons why younger patients with colorectal cancer tend to do more poorly,” Sandler told Healio. “But first, we would like to explore whether this was an institutional phenomenon or whether these figures are more broadly represented in national and international cancer registries.” – by Jennifer Southall
For more information:
Gideon Sandler, BSc (Med), MBBS (Hons I), MS, DCH, FRACS, can be reached at Westmead Hospital, P.O. Box 533, Wentworthville, NSW 2145, Australia; email: gideon.sandler@health.nsw.gov.au.
Perspective
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Christopher Lieu, MD
This well-performed retrospective review addresses an important, clinically relevant question by showing significantly lower OS and RFS rates among pediatric/adolescent patients with colorectal cancer vs. adults with the same malignancy. This study brings up several additional questions regarding differences in biology between the two groups that may impact the effectiveness of our current standard therapies. The younger population also had a higher incidence of peritoneal disease, suggesting that there is, indeed, a distinct difference in the behavior of this cancer in younger and older patients. Future investigations will need to focus on potential explanations for this difference, which could lead to better and more personalized therapies for early-onset colorectal cancer.
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