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Bejan V, Pîslaru M, Scripcariu V. Diagnosis of Peritoneal Carcinomatosis of Colorectal Origin Based on an Innovative Fuzzy Logic Approach. Diagnostics (Basel) 2022; 12:1285. [PMID: 35626439 PMCID: PMC9140813 DOI: 10.3390/diagnostics12051285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/08/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023] Open
Abstract
Colorectal cancer represents one of the most important causes worldwide of cancer related morbidity and mortality. One of the complications which can occur during cancer progression, is peritoneal carcinomatosis. In the majority of cases, it is diagnosed in late stages due to the lack of diagnostic tools capable of revealing the early-stage peritoneal burden. Therefore, still associates with poor prognosis and quality of life, despite recent therapeutic advances. The aim of the study was to develop a fuzzy logic approach to assess the probability of peritoneal carcinomatosis presence using routine blood test parameters as input data. The patient data was acquired retrospective from patients diagnosed between 2010-2021. The developed model focuses on the specific quantitative alteration of these parameters in the presence of peritoneal carcinomatosis, which is an innovative approach as regards the literature in the field and validates the feasibility of using a fuzzy logic approach in the noninvasive diagnosis of peritoneal carcinomatosis.
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Affiliation(s)
- Valentin Bejan
- Department of Surgery, Faculty of Medicine, “Gr. T. Popa” University of Medicine and Farmacy of Iași, 700115 Iasi, Romania;
| | - Marius Pîslaru
- Department of Engineering and Management, Faculty of Industrial Design and Business Management, “Gheorghe Asachi” Technical University of Iași, 700050 Iasi, Romania;
| | - Viorel Scripcariu
- Department of Surgery, Faculty of Medicine, “Gr. T. Popa” University of Medicine and Farmacy of Iași, 700115 Iasi, Romania;
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Early onset sporadic colorectal cancer: Worrisome trends and oncogenic features. Dig Liver Dis 2018; 50:521-532. [PMID: 29615301 DOI: 10.1016/j.dld.2018.02.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/09/2018] [Accepted: 02/12/2018] [Indexed: 02/07/2023]
Abstract
Early onset colorectal cancers, defined as arising before 50 years of age, are a growing health hazard in western and eastern countries alike. The incidence of colon and rectal cancers in young individuals is projected to increase by as much as 90% and 140%, respectively, by 2030. Although several known cancer risk factors (e.g. smoking, alcohol, dietary habits) have been investigated, there is no single compelling explanation for this epidemiological trend. While some early onset colorectal cancers have been associated with germline mutations in cancer predisposition genes, genetic syndromes are implicated in only a fraction of these cancers (20%) and do not explain the rising incidence. Colorectal neoplasms develop through microsatellite instability or chromosomal instability pathways, with most of the early onset colorectal cancers exhibiting microsatellite stable phenotypes. Genome-wide hypomethylation is a feature of a subgroup of early onset cancers, which appears to be correlated with chromosomal instability and poor prognosis.
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Günel N, Yamac D, Akcali Z, Taneri F, Oguz M. The Clinicopathologic Characteristics of Colorectal Cancer in Patients under 50 years of Age: Experience of an Oncology Center. TUMORI JOURNAL 2018; 87:74-7. [PMID: 11401210 DOI: 10.1177/030089160108700202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background/aim Colorectal cancer is seen mostly among patients older than 50 years of age. An aggressive behavior is a frequently cited as characteristic of colorectal cancer in young patients. The purpose of the present study was to reveal the clinicopathologic characteristics of colorectal cancer among patients under 50 years of age. Methods Two hundred and seventy-one patients with colorectal cancer admitted to our oncology center were evaluated, and clinicopathologic findings of the young and old patients were compared. Patient gender, site distribution, tumor stage classification, lymph node involvement, metastatic site, histologic classification, histologic differentiation, family history of malignant tumors, presenting symptoms and survival rates were compared. Results One hundred patients were 50 years of age or under. Clinical, histopathologic characteristics and overall survival of the two groups did not differ. A higher rate of familial cancer syndromes was detected among young patients. Conclusions The presentation and outcome of the disease in young patients do not differ from those of older patients. A significant family history of colorectal cancer in the young patients showed the need for screening whereas the outcome of metastatic disease was poor. In order to anticipate long survival, early detection and aggressive treatment is necessary.
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Affiliation(s)
- N Günel
- Department of Medical Oncology, Gazi University Medical School, Beşevler, Ankara, Turkey
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Poles GC, Clark DE, Mayo SW, Beierle EA, Goldfarb M, Gow KW, Goldin A, Doski JJ, Nuchtern JG, Vasudevan SA, Langer M. Colorectal carcinoma in pediatric patients: A comparison with adult tumors, treatment and outcomes from the National Cancer Database. J Pediatr Surg 2016; 51:1061-6. [PMID: 26703433 DOI: 10.1016/j.jpedsurg.2015.11.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/08/2015] [Accepted: 11/11/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Pediatric colorectal cancer (CRC) is rare. Comparison with adult CRC tumors, management, and outcomes may identify opportunities for improvement in pediatric CRC care. STUDY DESIGN CRC patients in the National Cancer Data Base from 1998 to 2011, were grouped into Pediatric (≤21years), early onset adult (22-50) and older adult (>50) patients. Groups were compared with χ(2) and survival analysis. RESULTS A total of 918 pediatric (Ped), 157,779 early onset adult (EA), and 1,304,085 older adults (OA) were identified (p<0.01 for all comparisons). Patients ≤50 presented more frequently with stage 3 and 4 disease (Ped: 62.0%, EA: 49.7%, OA: 37.3%) and rectal cancer (Ped: 23.6%, EA: 27.5%, OA: 19.2%). Pediatric histology was more likely signet ring, mucinous, and poorly differentiated. Initial treatment was usually surgery, but patients ≤50 were more likely to have radiation (Ped: 15.1%, EA: 18.6%, and OA: 9.2%) and chemotherapy (Ped: 42.0%, EA: 38.2%, and OA: 22.7%). Children and older adults showed poorer overall survival at 5years when compared to early onset adults. Adjusting for covariates, age ≤21 was a significant predictor of mortality for colon and rectal cancers (colon HR: 1.22, rectal HR: 1.69). CONCLUSIONS This is the largest cohort of pediatric CRC patients, revealing more aggressive tumor histology and behavior in children, particularly in rectal cancer. Despite standard oncologic treatment, age ≤21 was a significant predictor of mortality. This is likely owing to worse tumor biology rather than treatment disparities and may signal the need for different therapeutic strategies.
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Affiliation(s)
| | - David E Clark
- Department of Surgery, Maine Medical Center, Portland, ME
| | - Sara W Mayo
- Department of Surgery, Maine Medical Center, Portland, ME
| | - Elizabeth A Beierle
- Department of Surgery, Division of Pediatric Surgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham, AL
| | - Melanie Goldfarb
- Department of Surgery, John Wayne Cancer Institute, Providence St. John's Medical Center, Santa Monica, CA
| | - Kenneth W Gow
- Division of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA
| | - Adam Goldin
- Division of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA
| | - John J Doski
- Department of Surgery/Pediatric Surgery Division, University of Texas Health Science Center, San Rosa Children's Hospital, San Antonio, TX
| | - Jed G Nuchtern
- Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine, Houston, TX
| | - Sanjeev A Vasudevan
- Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine, Houston, TX
| | - Monica Langer
- Department of Surgery, Division of Pediatric Surgery, Tufts University School of Medicine, Maine Medical Center, Portland, ME.
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Kansakar P, Singh Y. Changing trends of colorectal carcinoma in Nepalese young adults. Asian Pac J Cancer Prev 2013; 13:3209-12. [PMID: 22994735 DOI: 10.7314/apjcp.2012.13.7.3209] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Colorectal carcinoma (CRC) is the most common gastrointestinal malignancy in the older population, but it is also quite frequent among young adults in developing countries. The aim of this study was to update the trends of clinicopathological features of CRC in young Nepalese. METHODS A retrospective comparative study on the data retrieved from the surgical records of all patients between 20 to 39 years of age with CRC was carried out for periods of 5 years each from 1999 to 2003 (early) and 2004 to 2008 (recent), treated at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. RESULTS The number of young adults with CRC increased from 28 to 34. However, the proportion of young patients in both groups was 28% of all CRC patients. The mean ages were 34±4.7 and 31.8±5.1 years in early and recent 5 years, respectively, and the male female ratio changed from 2:3 to 4:3. Abdominal pain as the most common presenting symptom was replaced by bleeding per rectum in recent years. The mean duration from onset of symptoms to seeking medical advice decreased from 7.8 months to 5.6 months in recent years. More patients (85.3%) were subjected to endoscopic examination in recent years than early years (60.7%) and right colonic cancer increased from 10.7% to 26.5%. However, the rectum was the commonest site in both early (71.4%) and recent (50%) groups. CRC was detected significantly at an earlier stage (7.1% vs 32.4%) in recent years with large proportion of modified Dukes B stage. Poorly differentiated adenocarcinoma was the predominant histology in both groups (50% vs 60.7%). Curative resection had risen in recent years (39.3% vs 73.6%). CONCLUSION CRC among Nepalese young adults accounts for a high incidence (28%) of all CRC cases. Although right sided colonic cancer has been increasing, rectum is the commonest site. There is also an increasing trend for diagnosis at earlier stages of the disease which can be treated with curative intent.
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Affiliation(s)
- Prasan Kansakar
- Department of Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, Nepal.
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Saeed NM, Bawazir AA, Al-Zuraiqi M, Al-Negri F, Yunus F. Why is hepatocellular carcinoma less attributable to viral hepatitis in Yemen? Asian Pac J Cancer Prev 2013; 13:3663-7. [PMID: 23098451 DOI: 10.7314/apjcp.2012.13.8.3663] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The hepatitis B virus (HBV) and the hepatitis C virus (HCV) are still public health problems in Yemen, with older individuals having much higher prevalence than younger generations. However, research on the prevalence of viral hepatitis in association with hepatocellular cancer (HCC) has not yet been undertaken in Yemen. The aim of this study was to determine the prevalence of HBV and HCV infection among HCC patients and to estimate the risk of these infections being associated with the development of HCC. A cross-sectional study was conducted on patients attending oncology outpatient in Sana'a, Yemen, through the period 2008-mid 2010 with confirmed diagnosis of HCC. A total of 88 cases were studied thoroughly with different investigations such as CT-scan, ultrasound, tumour marker, alpha-feto-protein and histopathological biopsy. A structured questionnaire was also applied and physical examination done to assess the general condition of the patients. Statistical package (SPSS version 16) was used for analysis of the data. The mean age of the cases was 61.2 years (± 12.6) with half over 60 years. There were fewer male patients (36%) compared to females and most (97%) only had basic /no formal education. Seventy nine (89%) were diagnosed as HCC cases with histopathological biopsy while the rest were diagnosed by ultrasound, CT scan, tumour marker, and alpha-feto-protein. Around one-third of the subjects were positive for HBsAg and HCV antibodies. Multivariate analysis showed infection with HCV and use of smoking was associated with HCC diagnosis. Although an association was observed between the occurrence of HCC and viral hepatitis (either HBV or HCV) and cigarette smoking, but the rate of viral infection was lower than what has been reported elsewhere.
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Wani M, Afroze D, Makhdoomi M, Hamid I, Wani B, Bhat G, Wani R, Wani K. Promoter methylation status of DNA repair gene (hMLH1) in gastric carcinoma patients of the Kashmir valley. Asian Pac J Cancer Prev 2013; 13:4177-81. [PMID: 23098428 DOI: 10.7314/apjcp.2012.13.8.4177] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Cancer is a multi-factorial disease and variation in genetic susceptibility, due to inherited differences in the capacity to repair mismatches in the genome, is an important factor in the development of gastric cancer (GC), for example. Epigenetic changes, including aberrant methylation of 5/CpG islands in the promoter regions of mismatch repair (MMR) genes like hMLH1, have been implicated in the development of various types of GC. In the present study we evaluated the role of hMLH1 promoter hypermethylation in Kashmiri GC patients and controls, and assessed correlations with various dietary and lifestyle factors. The study included 70 GC patients (56 males and 14 females; age (mean ± S.D) 50 ± 11.4 years). Distinction between methylated and unmethylated was achieved with MS-PCR and DNA band patterns. The Chi-square test was applied to assess the risk due to promoter hypermethylation. We found a strikingly high frequency of promoter hypermethylation in GC cases than in normal samples (72.9% (51/70) in GC cases vs 20% (14/70) in normal samples (p=0.0001). We also observed a statistically significant association between methylated hMLH1 gene promoter and smoking, consumption of sundried vegetables and hot salted tea with the risk of GC. This study revealed that hMLH1 hypermethylation is strongly associated with GC and suggested roles for epigenetic changes in stomach cancer causation in the Kashmir valley.
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Affiliation(s)
- Majid Wani
- Department of General Surgery, Sher I Kashmir Institute of Medical Sciences, Srinagar, India
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Tunca B, Tezcan G, Cecener G, Egeli U, Zorluoglu A, Yilmazlar T, Ak S, Yerci O, Ozturk E, Umut G, Evrensel T. Overexpression of CK20, MAP3K8 and EIF5A correlates with poor prognosis in early-onset colorectal cancer patients. J Cancer Res Clin Oncol 2013; 139:691-702. [PMID: 23322277 DOI: 10.1007/s00432-013-1372-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 01/03/2013] [Indexed: 01/05/2023]
Abstract
PURPOSE Due to ethnic, genetic and environmental factors, the clinical and molecular characteristics of Turkish colorectal cancer (CRC) patients are different from those of Western populations. The aim of this study was to clarify the relevant alterations of gene expression associated with colorectal carcinogenesis in early-onset patients and to identify specific biomarkers that could provide novel therapeutic molecular targets in this population. METHODS The expression profiles of 114 different genes were evaluated using mRNA PCR arrays in 39 tumors and 20 surgical margin tissue samples from 39 sporadic CRC patients diagnosed at less than 50 years of age. RESULTS The expression levels of IMPDH2, CK20, MAP3K8 and EIF5A were strongly up-regulated in CRC tissues compared with normal colorectal tissues (p < 0.05). The highly significant expression ratios of CK20, MAP3K8 and EIF5A observed in the colorectal tumors of patients predicted recurrence (p < 0.05). The expression of IMPDH2, CK20, MAP3K8 and EIF5A was significantly higher in the tumors of patients with short median survival (log-rank p value < 0.05). Progression-free survival was also significantly increased in patients with low expression of the EIF5A gene compared with those who exhibited high expression of this gene (log-rank p value < 0.05). CONCLUSION We demonstrated that high CK20, MAP3K8 and EIF5A expression levels were significant prognostic factors for poor overall survival in CRC patients. Further studies and validations are required; these genes may provide novel therapeutic molecular targets for CRC treatment, as well as new directions for the development of anticancer drugs.
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Affiliation(s)
- Berrin Tunca
- Department of Medical Biology, Medical Faculty, Uludag University, Bursa, Turkey.
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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: 35] [Impact Index Per Article: 3.2] [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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Colorectal carcinoma in different age groups : a histopathological analysis. Int J Colorectal Dis 2012; 27:249-55. [PMID: 21845417 DOI: 10.1007/s00384-011-1299-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2011] [Indexed: 02/04/2023]
Abstract
PURPOSE Although colorectal cancer is typical in the older population, tumor onset before age 40 is not infrequent. However, the behavior, characteristics, and prognosis of this disease in young patients are unclear when compared to the older population. It is believed that young patients have a poor prognosis. We hypothesized that young patients have a poor prognosis because they have advanced-stage cancer with more aggressive pathologic features. METHODS Using a university hospital database, we analyzed the histopathological features of three groups of patients with a diagnosis of colorectal cancer: young age group (patients 40 years and younger), intermediate age group (patients 41-80 years old), and old age group (patients 81 years and older). RESULTS A total of 653 cases of colorectal cancer were analyzed. The young age group comprised 48 patients (7.4%), the intermediate age group comprised 538 patients (82.4%) and the old age group consisted of 67 patients (10.3%).The gender distribution was similar between the groups. The mean age of the young, intermediate, and old age groups were 34.5 (±5.0), 61.7 (±11.1) and 85.1 (±4.6) years old, respectively. The pathological features analyzed such as lymph node involvement, tumor histological classification and grade, venous, neural and lymphatic invasion, T and N classification of the TNM System, and Astler-Coller classification were similar between the age groups. CONCLUSIONS The colorectal histopathological features in young patients are similar to older patients. More aggressive characteristics or more advanced stage are not seen in younger patients.
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Chew MH, Koh PK, Ng KH, Eu KW. Improved survival in an Asian cohort of young colorectal cancer patients: an analysis of 523 patients from a single institution. Int J Colorectal Dis 2009; 24:1075-83. [PMID: 19387661 DOI: 10.1007/s00384-009-0701-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2009] [Indexed: 02/04/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) in the young is rare. Outcomes remain varied compared to older populations. The study reviews characteristics and overall survival (OS) of CRC in patients < or =50 years old. MATERIALS AND METHODS Five hundred and twenty-three (14%) of 3,796 sporadic CRCs were identified. Patients were compared for demographics, tumour characteristics, treatment, and 5-year overall specific survival. Independent prognostic factors were evaluated. RESULTS The majority were males (54%) with a median age of 45 years (range 19-50 years). Sixty-three percent of the patients presented with advanced stage disease (stage III and IV), and tumours were predominantly left-sided (83%). A higher frequency of mucinous or signet ring cell histological subtypes (16% vs 9%, p = 0.028) as well as poorly differentiated tumours (30% vs 12%, p = 0.0001) were present in younger patients < or =40 years. With a median follow-up of 41 months, the 5-year OS is 58% (95% confidence interval 53-64%). Younger patients < or =40 years had significantly superior 5-year OS of 62% vs 58% in the age group 41-50 years old (p = 0.004). Multivariate analysis identified five independent prognostic features: age group of 41-50 years, poorly differentiated tumour grade, presence of perineural infiltration, high tumour stage, and carcinoembryonic antigen values > or =5 ng/ml. CONCLUSION This study has revealed significantly improved 5-year survival in young CRC compared to those reported in the literature.
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Affiliation(s)
- Min-Hoe Chew
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
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Arai T, Takubo K. Clinicopathological and molecular characteristics of gastric and colorectal carcinomas in the elderly. Pathol Int 2007; 57:303-14. [PMID: 17539960 DOI: 10.1111/j.1440-1827.2007.02101.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The occurrence of malignant neoplasms increases with advancing age. Although aging and carcinogenesis are basically different processes, there are phenomena common to each such as accumulation of DNA damage and abnormal proteins. Gastric and colorectal carcinomas are representative tumors in which the prevalence and the number of patients increase significantly with age. Compared with gastric and colorectal cancers occurring in younger patients, those occurring in older patients have clinicopathological differences in tumor location, gender distribution, histological type, histological diversity, multiplicity, incidence of lymph node metastasis, and prognosis. In the elderly there are peculiar types of carcinoma such as medullary-type poorly differentiated colorectal adenocarcinoma and solid-type poorly differentiated gastric adenocarcinoma, both of which occur in older women. Methylation, apoptosis, and telomere dysfunction play important roles in the development of gastric and colorectal cancers in the elderly.
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Affiliation(s)
- Tomio Arai
- Department of Pathology, Tokyo Metropolitan Geriatric Hospital, Sakaecho, Tokyo, Japan.
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Tunca B, Menigatti M, Benatti P, Egeli U, Cecener G, Pedroni M, Scarselli A, Borghi F, Sala E, Yilmazlar T, Zorluoglu A, Yerci O, de Leon MP. Investigation of APC mutations in a Turkish familial adenomatous polyposis family by heterodublex analysis. Dis Colon Rectum 2005; 48:567-71. [PMID: 15719192 DOI: 10.1007/s10350-004-0799-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Familial adenomatous polyposis is an autosomal dominant disease characterized by the presence of 100 or more colorectal adenomatous polyps. Mutations in the adenomatous polyposis coli gene are primarily responsible for the development of this disease. This study was designed to investigation of adenomatous polyposis coli (APC) gene mutations in members of familial adenomatous polyposis family to identify individuals at risk of the disease. METHODS We examined one patient with familial adenomatous polyposis and 21 family members including one affected person from familial adenomatous polyposis and 20 nonsymptomatic persons. We studied E, D, F, and G segments of exon 15 of the adenomatous polyposis coli gene by heteroduplex analysis. RESULTS We used silver staining method for staining. We found a mutation for five persons at segment F of exon 15 of the adenomatous polyposis coli gene. Two of them were affected by colorectal cancer, one of whom was the proband, and the other three were nonsymptomatic family members. The pathogenetic mutation was a T deletion at codon 1172, causing a frameshift in the adenomatous polyposis coli gene, as a result of the sequencing analysis of these cases. CONCLUSIONS Investigation of adenomatous polyposis coli gene mutations is very important for the identification of genetic susceptibility to colorectal cancer and for the definition of tumor developing at an early stage. Furthermore, the identification of this mutation for the first time in a Turkish family will be useful to foster further studies on familial adenomatous polyposis in Turkey.
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Affiliation(s)
- Berrin Tunca
- Department of Medical Biology and Genetics, Faculty of Medicine, Uludag University, Bursa, Turkey.
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O'Connell JB, Maggard MA, Liu JH, Etzioni DA, Ko CY. Are survival rates different for young and older patients with rectal cancer? Dis Colon Rectum 2004; 47:2064-9. [PMID: 15657655 DOI: 10.1007/s10350-004-0738-1] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Although it is generally believed that young patients with rectal cancer have worse survival rates, no comprehensive analysis has been reported. This study uses a national-level, population-based cancer registry to compare rectal cancer outcomes between young vs. older populations. METHODS All patients with rectal carcinoma in the Surveillance, Epidemiology, and End Results cancer database from 1991 to 1999 were evaluated. Young (range, 20-40 years; n = 466) and older groups (range, 60-80 years; n = 11,312) were compared for patient and tumor characteristics, treatment patterns, and five-year overall and stage-specific survival. Cox multivariate regression analysis was performed to identify predictors of survival. RESULTS Mean ages for the groups were 34.1 and 70 years. The young group was comprised of more black and Hispanic patients compared with the older group (P < 0.001). Young patients were more likely to present with late-stage disease (young vs. older: Stage III, 27 vs. 20 percent respectively, P < 0.001; Stage IV, 17.4 vs. 13.6 percent respectively, P < 0.02). The younger group also had worse grade tumors (poorly differentiated 24.3 vs. 14 percent respectively, P < 0.001). Although the majority of both groups received surgery (85 percent for each), significantly more young patients received radiation (P < 0.001). Importantly, overall and stage-specific, five-year survival rates were similar for both groups (P = not significant). CONCLUSIONS Although previous studies have found young rectal cancer patients to have poorer survival compared with older patients, this population-based study shows that young rectal cancer patients seem to have equivalent overall and stage-specific survival.
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Affiliation(s)
- Jessica B O'Connell
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California 90095, USA.
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O'Connell JB, Maggard MA, Liu JH, Etzioni DA, Livingston EH, Ko CY. Do Young Colon Cancer Patients Have Worse Outcomes? World J Surg 2004; 28:558-62. [PMID: 15366745 DOI: 10.1007/s00268-004-7306-7] [Citation(s) in RCA: 174] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Previous studies on colon cancer have noted rising incidence rates among young individuals and suggest that they may have more aggressive disease and worse 5-year survivals than their older counterparts. Our study uses a nationwide population-based cancer registry to analyze colon cancer presentations and outcomes in a young versus an older population. The records of patients with colon carcinoma were obtained from the Surveillance, Epidemiology, and End Results (SEER) national cancer database (1991-1999). Two cohorts based on age at diagnosis (20-40 years, n = 1334 vs. 60-80 years, n = 46,457) were compared for patient and tumor characteristics, treatment, and 5-year cancer-specific survival. A multivariate Cox regression was performed to identify predictors of survival. The young group had a higher proportion of black and Hispanic patients than did the older group (p < 0.001). Young patients had less stage I or II disease, more stage III or IV disease (p < 0.001), and worse-grade (poorly differentiated or anaplastic) tumors (p < 0.001). The 5-year stage-specific survival was similar for stage I and III disease (p = NS) but was significantly better for young patients with stage II and IV disease (p < 0.01). Using a nationally representative cancer registry, we found that young colon cancer patients tend to have later-stage and higher-grade tumors. However, they have equivalent or better 5-year cancer-specific survival compared to older patients. This population-based finding contradicts prior single-institution reports.
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Affiliation(s)
- Jessica B O'Connell
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90095, USA.
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O'Connell JB, Maggard MA, Livingston EH, Yo CK. Colorectal cancer in the young. Am J Surg 2004; 187:343-8. [PMID: 15006562 DOI: 10.1016/j.amjsurg.2003.12.020] [Citation(s) in RCA: 234] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2003] [Revised: 06/16/2003] [Indexed: 12/12/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is generally thought of as a disease of older persons; however a significant proportion of patients <40 years present with this disease. Many investigators have published single-institution series on CRC in the young, yet the data vary markedly. We performed a structured review of the current literature aiming to (1) characterize CRC in the young population and (2) determine how CRC in this population should be further addressed regarding detection and treatment. DATA SOURCES A Medline literature search was completed. Articles were chosen to include those studies that examined patients <40 years old. A total of 55 articles were chosen from the search and review of the bibliographies. CONCLUSIONS We found that CRC in the young population appears to be more aggressive, to present with later stage, and to have poorer pathologic findings. However, if detected early, young patients with Dukes' stage A or B lesions have better overall 5-year survival rates. These findings emphasize the need for health care providers to have a heightened awareness when caring for this young population, particularly because excellent modalities exist to diagnose and treat colorectal cancer.
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Affiliation(s)
- Jessica B O'Connell
- Department of Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.
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O'Connell JB, Maggard MA, Liu JH, Etzioni DA, Livingston EH, Ko CY. Rates of Colon and Rectal Cancers are Increasing in Young Adults. Am Surg 2003. [DOI: 10.1177/000313480306901010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Incidence rates for colorectal cancer are decreasing in the United States, possibly due to preventative cancer screening. Because these programs target older patients, their beneficial effects may not apply to young patients. The purpose of this study was to compare incidence rates and tumor characteristics of colon and rectal cancers for young versus older patients using a population-based cancer registry. Colon and rectal cancer patients reported in the Surveillance, Epidemiology, and End Results registry (1973–1999) were separately analyzed. Incidence rates over time, stage, and grade were compared for two age groups: young patients (20–40 years, n = 5383) and older patients (60+ years, n = 256,401). For older patients, colon cancer incidence remained stable while rectal cancer incidence decreased 11 per cent to 72.1/100,000 persons ( P < 0.05). For the young, colon cancer incidence increased 17 per cent to 2.1 ( P < 0.05), and rectal incidence rose 75 per cent to 1.4 ( P < 0.05). Young patients had less localized tumors than older patients: colon (25.8% vs. 35.3%, P < 0.001); rectal (38.4% vs. 41.7%, P = 0.005). Young patients also had more poorly differentiated tumors: colon (22.2% vs. 14.7%, P < 0.001); rectal (16.4% vs. 12.3%, P < 0.001). Incidence rates for colon and rectal cancers in young patients are rising, and they have more advanced disease. Although the overall prevalence is low in this population, the increasing incidence suggests health-care providers should have heightened awareness when caring for this population.
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Affiliation(s)
- Jessica B. O'Connell
- From the Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
- Department of Surgery, West Los Angeles Veteran Affairs Hospital, Los Angeles, California
| | - Melinda A. Maggard
- From the Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
- Department of Surgery, West Los Angeles Veteran Affairs Hospital, Los Angeles, California
| | - Jerome H. Liu
- From the Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
- Department of Surgery, West Los Angeles Veteran Affairs Hospital, Los Angeles, California
| | - David A. Etzioni
- From the Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Edward H. Livingston
- Department of Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Clifford Y. Ko
- From the Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
- Department of Surgery, West Los Angeles Veteran Affairs Hospital, Los Angeles, California
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Sahraoui S, Acharki A, Tawfiq N, Jouhadi H, Bouras N, Benider A, Kahlain A. [Colorectal cancer in patients younger than 40 years of age]. Cancer Radiother 2000; 4:428-32. [PMID: 11191849 DOI: 10.1016/s1278-3218(00)00021-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Between 1988 and 1994, 326 patients with colorectal cancers were treated at the Ibn Rochd Oncology Centre in Casablanca; 88 patients were less than 40 years old (27%). There were 79 males and nine females. A family history of colorectal cancer was noted in 5%. The most frequent symptoms were bleeding and rectal pain. The localisation of the tumour was the rectum in 70 cases. According to the anatomopathological profile, Dukes stages C and D were the most frequent and mucosal adenocarcinoma was noted in 24 cases. Seventy patients had surgery, associated with radiation therapy in 59 cases. Adjuvant chemotherapy was given in 44 cases and palliative treatment in 17 cases. Recurrence occurred in 14 cases and metastasis in other six cases. At five years, overall survival and disease-free survival rates were 24% and 17%, respectively. Worse prognostic factors were mucosal adenocarcinoma, poor differentiated adenocarcinoma and Dukes C and D stages.
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Affiliation(s)
- S Sahraoui
- Centre d'oncologie, CHU Ibn Rochd, Casablanca, Maroc.
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Arai T, Takubo K, Sawabe M, Esaki Y. Pathologic characteristics of colorectal cancer in the elderly: a retrospective study of 947 surgical cases. J Clin Gastroenterol 2000; 31:67-72. [PMID: 10914781 DOI: 10.1097/00004836-200007000-00016] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
To determine the pathologic characteristics of colorectal cancer in the very old, a retrospective study of 947 consecutive Japanese patients aged > or =65 with 1,039 lesions were examined. Pathologic findings in the very old group (>85 years, n = 140) were compared with those in the younger groups; young-old group (65-74 years, n = 352) and middle-old group (75-84 years, n = 455). Although male:female ratio significantly decreased with advancing age, reaching 1:1.8 in the very old group, the relative odds of colorectal cancer in men were higher than that in women in all age groups. In the very old group, cancer of the proximal colon (proximal to the splenic flexure) accounted for 52% in women and 37% in men, being significantly higher than those in the younger groups. Proximal colonic cancers increased with advancing age in both genders. Higher proportions of poorly differentiated adenocarcinoma, mucinous carcinoma, cancer >5 cm in size, and protruding type cancer were present in the very old group, although these kinds of tumors typically occur in the proximal colon. The incidence of multiple cancers in the large intestine was not different among any age group (average, 8.6%). These results indicated that, even in the very old, colorectal cancers showed marked proximal excess, being explained by effect of both age and gender, and that the proximal shift may influence the proportion of histologic type and size of the tumor. These findings have important implications for screening and diagnosis of colorectal cancer in the elderly.
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Affiliation(s)
- T Arai
- Department of Pathology, Tokyo Metropolitan Geriatric Hospital, Japan
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Abstract
BACKGROUND Young patients with colorectal carcinomas are considered to have a worse prognosis than older patients. It was the goal of this study to assess if biologic characteristics of tumors in young patients differ from those observed in 2 different groups of patients with the same clinical characteristics but ranging in age either from 41 to 60 years or 61 years and older, respectively. METHODS Colorectal carcinoma tumor samples were obtained from storage from patients age 40 years and younger and examined for tumor ploidy and S-phase fraction. For each younger patient, a control was selected among patients matched for Dukes stage, site of primary tumor, and sex, with the two age groups. RESULTS Thirty-one of 1361 patients (2.2%) with colorectal carcinoma treated at our institution between 1984 and 1994 age 40 years or younger. Tumor aneuploidy was present in 3 younger patients, in 5 patients in the 41 to 60 years age group, and in 5 patients in the 61 years and older age group. S-phase fraction was 27.67 +/- 13.62 in patients younger than 40 years, 25.35 +/- 11.6 in the 40 to 61 years age group, and 22.45 +/- 8.48 in the 61 years and older age group. These differences were not statistically significant. CONCLUSIONS It appears that there are no significant differences in S-phase fraction and tumor aneuploidy in patients younger or older than 40 years, suggesting that colorectal tumors arising in young people do not have different biologic properties.
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Affiliation(s)
- S Cascinu
- Servizio d. Oncologia, Azienda Ospedaliera S. Salvatore, Pesaro, Italy
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