Abstract
Objective
The aim was to identify the clinical factors and tumour characteristics that predict survival in patients younger than 40 years with colorectal adenocarcinoma.
Material and methods
Fifty-nine patients with colorectal cancer aged under 40 years were identified from a computer database, and their clinical variables were analysed. The factors predicting long-term survival were compared by both univariate and multivariate analysis.
Results
The prevalence of positive family history of cancer was 27%, and predisposing factors were present in 31% of the patients. All patients underwent resective surgery, 76% radical and 24% palliative resection, and their 5-year survival was 59% and mean survival ±75 months. The recurrence rate after radical resection was 38% being 14%, 30%, 78% and 100% in Dukes classes A, B, C and D. The cumulative 5-year survival of men, 45%, was significantly worse than that of women, 73%, and this phenomenon was closely related to more distended lymphatic and venous invasion of cancer in men. Kaplan–Meier estimates showed that gender, Dukes staging, grade of tumour, lymphatic invasion, the number of lymph nodes with metastases, venous invasion and size of tumour were significant predictors of survival, but in Cox regression model, only venous invasion was the independent prognostic factor of survival.
Conclusions
Young men with colorectal cancer in Northern Finland have poorer prognosis than women. Venous invasion is an independent predictor of survival.
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References
Institute for Statistical and Epidemiological Cancer Research (2004) Finnish Cancer Registry—Cancer incidence in Finland. Institute for Statistical and Epidemiological Cancer Research, Helsinki
Cusack JC, GiaccO CC, Cleary K, Davidson BS, Izzo F, Skibber J, Yen J, Curley SA (1996) Survival factors in 183 patients younger than 40 years old with colorectal adenocarcinoma. J Am Coll Surg 183:105–112
Domerque J, Ismail M, Astre C, Saint-Aubert J, Joyex H, Solassol C, Pujol H (1988) Colorectal carcinoma in patients younger than 40 ears of age. Montpellier cancer institute experience with 78 patients. Cancer 61(4):835–840
Smith C, Butler JA (1989) Colorectal cancer in patients younger than 40 years of age. Dis Colon Rectum 32:843–846
Palmer ML, Herrera L, Petrelli NJ (1991) Colorectal adenocarcinoma in patients less than 40 years of age. Dis Colon Rectum 34:322–325
Adloff M, Arnaud JP, Schoegel M, Thibaud D, Bergamashi R (1986) Colorectal cancer in patients under 40 years of age. Dis Colon Rectum 29:322–325
Paraf F, Jothy S (2000) Colorectal cancer before the age of 40. Dis Colon Rectum 43:1222–1226
Chung YFA, MachinD EuK-W, Ho JMS, Nyam DCNK, Leong AFPK, Ho YH, Seow-Choen F (1988) Young age is not a poor prognostic marker in colorectal cancer. Br J Surg 85:1255–1259
Turnbull RB, Kyle K, Watson FR, Spratt J (1967) Cancer of the colon, the influence of non-touch isolation technic on survival rates. Ann Surg 166:420–427
Jass JR, Sobin LH (1989) Histologic typing of intestinal tumours. World Health Organisation. International classification of tumours, 2nd edn. Springer, Heidelberg
Mäkelä JT, Laitinen ST, Kairaluoma MI (1995) Five-year follow-up after radical surgery for colorectal cancer. Arch Surg 130:1062–1067
Fante R, Benatti P, di Gregorio C, De Pietri S, Pedroni M, Tamassia MG, Percesepe A, Rossi G, Losi L, Roncucci L, Ponz de Leon M (1997) Colorectal carcinoma in different age group: a population based investigation. Am J Gastroenterol 92:1505–1509
Järvinen HJ, Turunen MJ (1984) Colorectal cancer before 40 years of age: prognosis and predisposing conditions. Scand J Gastroenterol 19:634–838
O’Connell JB, Maggard MA, Livingston EH, Yo CK (2003) Colorectal cancer in the young. Am J Surg 187:343–348
Fuchs CS, Giovannuchi EL, Colditz GA, Hunter DJ, Speizer FE, Willett WC (1994) NEJM 331:1669–1674
Guillem JG, Bastar AL, Ng J, Huhn JL, Cohen AM (1996) Clustering of colorectal cancer in families of probands under 40 years of age. Dis Colon Rectum 39:1004–1007
Mitry E, Benhamiche A-M, Jouve J-L, Clinard F, Finn-Faivre C, Faivre J (2001) Colorectal adenocarcinoma in patients under 45 years of age: comparison with older patients in a well-defined French population. Dis Colon Rectum 44:380–387
Fante R, Benatti P, di Gregorio C, De Pietri S, Pedroni M, Tamassia MG, Percesepe A, Rossi G, Losi L, Roncucci L (1997) Ponz de Leon M. Am J Gastroenterol 92:1505–1509
Bokey EL, Chapuis PH, Dent OF, Newland RC, Koorey SG, Zelas PJ, Etewart PJ (1997) Factors affecting survival after excision of the rectum for cancer. Dis Colon Rectum 40:3–10
Liang JT, Huang KC, Cheng AL, Wu JYM, MS WSM (2002) Clinicopathological and molecular biological features of colorectal cancer in patients less than 40 years of age. Br J Surg 90:205–214
King-Yin Lam A, Ong K, Ho YH (2006) Coloretal mucinous adenocarcinoma: the clinicopathological features and significance of p16 and p53 expression. Dis Colon Rectum 49:1275–1283
Bulow S (1980) Colorectal cancer in patients less than 40 years of age in Denmark, 1943–1956. Dis Colon Rectum 23:327–336
Grossman S, Milos ML (1988) Colonoscopic screening of persons with suspected risk factors for colon cancer: I family history. Gastroenterology 94:395–400
Menges M, Gärtner B, Georg T, Fischinger J, Zeitz M (2006) Cost-benefit analysis of screening colonoscopy in 40-to 50-year old first-degree relatives of patients with colorectal cancer. Int J Colorectal Dis 21:596–601
Isbister WH, Fraser J (1990) Large bowel cancer in the young: a national survey study. Dis Colon Rectum 33:363–366
Koopman TJ, Cats A, Rodenburg CA, Creemers GJ, Scharma JG, Erdkamp FL, Vos AH, van Groeningen CJ, Sinnige HA, Richel DJ, Voest EE, Dijktra JR, Vink-Börger ME, Antonini NF, Mol L, van Krieken JH, Dalesio O, Punt CJ (2009) Chemotherapy, bevacitzumab, and cetuximab in metastatic colorecla cancer. N Engl J Med 360:563–572
Negri FV, Wotherspoon A, Cunningham D, Norman AR, Chong G, Ross PJ (2005) Mucinous histology predicts for reduced fluorouracil responsiveness and survival in advanced colorectal cancer. Ann Oncol 16:1305–1310
Catalano V, Loupakis F, Graziano F, Torresi U, Bisonni R, Mari D, Fornaro L, Baldelli AM, Giordani P, Rossi D, Alessadroni P, Giustini L, Silva RR, Falcone A, D’Emidio S, Fedeli SL (2009) Mucous histology predicts for poor response related overall survival of patients with colorectal cancer and treated with first-line oxaliplatin-and/or irinotecan-based chemotherapy. Br J Cancer 100:881–887
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Mäkelä, J.T., Kiviniemi, H. Clinicopathological features of colorectal cancer in patients under 40 years of age. Int J Colorectal Dis 25, 823–828 (2010). https://doi.org/10.1007/s00384-010-0914-9
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DOI: https://doi.org/10.1007/s00384-010-0914-9