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Medici B, Riccò B, Caffari E, Zaniboni S, Salati M, Spallanzani A, Garajovà I, Benatti S, Chiavelli C, Dominici M, Gelsomino F. Early Onset Metastatic Colorectal Cancer: Current Insights and Clinical Management of a Rising Condition. Cancers (Basel) 2023; 15:3509. [PMID: 37444619 DOI: 10.3390/cancers15133509] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Despite a recent overall decrease in colorectal cancer (CRC) incidence and mortality, there has been a significant rise in CRC diagnoses in young adults. Early onset colorectal cancer (EOCRC) is defined as CRC diagnosed before the age of 50. Possible predisposing conditions include not only genetic syndromes but also other risk factors, such as microbiome alteration, antibiotic exposure, obesity, diabetes mellitus, and inflammatory bowel disease. EOCRC tends to be diagnosed later than in the older counterpart because of a lack of awareness and the fact that screening for CRC usually starts at the age of 50. Furthermore, CRC in young adults seems to be related to unique molecular features and more aggressive clinical behavior. This paper aims to provide an in-depth review of this poorly understood subject, with a comprehensive review of the state of the art and considerations for future perspectives.
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Affiliation(s)
- Bianca Medici
- Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy
| | - Beatrice Riccò
- Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy
| | - Eugenia Caffari
- Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy
| | - Silvia Zaniboni
- Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy
| | - Massimiliano Salati
- Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy
| | - Andrea Spallanzani
- Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy
| | - Ingrid Garajovà
- Medical Oncology Unit, University Hospital of Parma, 43100 Parma, Italy
| | - Stefania Benatti
- Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy
| | - Chiara Chiavelli
- Laboratory of Cellular Therapy, Division of Oncology, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Massimo Dominici
- Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy
| | - Fabio Gelsomino
- Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy
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Son IT, Kang JH, Kim BC, Park JH, Kim JW. A Retrospective Multicenter Study of the Clinicopathological Characteristics and Prognosis of Young Adult Patients with Colorectal Cancer: Effects of Chemotherapy on Prognosis. J Clin Med 2023; 12:jcm12113634. [PMID: 37297829 DOI: 10.3390/jcm12113634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The objective of this study was to evaluate clinicopathologic features of young patients with colorectal cancer (CRC) and to compare their prognosis with those of older patients Methods: We retrospectively reviewed the medical records of patients who underwent surgery for stage 0-III CRC at four university-affiliated hospitals between January 2011 and December 2020. The patients were divided into two groups, the young adult group (≤45 years) and the older group (>45 years). RESULTS Of 1992 patients, 93 (4.6%) were young adults and 1899 (95.3%) were older patients. Young patients showed more symptoms (p = 0.014) and more poorly or undifferentiated adenocarcinoma (p = 0.047) than older patients. The young adult patients were more likely to receive adjuvant chemotherapy (p < 0.001) and multidrug agents (p = 0.029), and less likely to cease chemotherapy (p = 0.037). The five-year RFS (recurrence-free survival) rate was better in the young adults than in the older patients (p = 0.009). In the multivariable analysis, young age was a significant prognostic factor for better RFS (p = 0.015). CONCLUSIONS Young patients with CRC had more symptoms, aggressive histological features than older patients. They received more multidrug agents and discontinued chemotherapy less often, resulting in better prognosis.
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Affiliation(s)
- Il Tae Son
- Department of Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si 445-907, Republic of Korea
| | - Jae Hyun Kang
- Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 40, Sukwoo-Dong, Hwaseong-si 445-170, Republic of Korea
| | - Byung Chun Kim
- Department of Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 948-1, 1, Shingil-ro, Yeongdeungpo-gu, Seoul 150-950, Republic of Korea
| | - Jun Ho Park
- Department of Surgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 445 Gil-1-dong, Gangdong-gu, Seoul 134-701, Republic of Korea
| | - Jong Wan Kim
- Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 40, Sukwoo-Dong, Hwaseong-si 445-170, Republic of Korea
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Skalitzky MK, Zhou PP, Goffredo P, Guyton K, Sherman SK, Gribovskaja-Rupp I, Hassan I, Kapadia MR, Hrabe JE. Characteristics and symptomatology of colorectal cancer in the young. Surgery 2023; 173:1137-1143. [PMID: 36872174 PMCID: PMC10116569 DOI: 10.1016/j.surg.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/22/2022] [Accepted: 01/30/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND The incidence of colorectal cancer in patients <50 years has rapidly risen recently. Understanding the presenting symptoms may facilitate earlier diagnosis. We aimed to delineate patient characteristics, symptomatology, and tumor characteristics of colorectal cancer in a young population. METHODS A retrospective cohort study was conducted evaluating patients <50 years diagnosed between 2005 and 2019 with primary colorectal cancer at a university teaching hospital. The number and character of colorectal cancer-related symptoms at presentation was the primary outcome measured. Patient and tumor characteristics were also collected. RESULTS Included were 286 patients with a median age of 44 years, with 56% <45 years. Nearly all patients (95%) were symptomatic at presentation, with 85% having 2 or more symptoms. The most common symptoms were pain (63%), followed by change in stool habits (54%), rectal bleeding (53%), and weight loss (32%). Diarrhea was more common than constipation. More than 50% had symptoms for at least 3 months before diagnosis. The number and duration of symptoms were similar in patients older than 45 compared to those younger. Most cancers were left-sided (77%) and advanced stage at presentation (36% stage III, 39% stage IV). CONCLUSION In this cohort of young patients with colorectal cancer, the majority presented with multiple symptoms having a median duration of 3 months. It is essential that providers be mindful of the ever-increasing incidence of colorectal malignancy in young patients, and that those with multiple, durable symptoms should be offered screening for colorectal neoplasms based on symptoms alone.
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Affiliation(s)
- Mary Kate Skalitzky
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Peige P Zhou
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL
| | - Paolo Goffredo
- Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Kristina Guyton
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Scott K Sherman
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA
| | | | - Imran Hassan
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Muneera R Kapadia
- Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Jennifer E Hrabe
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA.
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Wang S, Yuan Z, Ni K, Zhan Y, Zhao X, Liu Z, Liu Y, Yi B, Lai S, Yin X, Zhou X, Wang Y, Ping H, Xin R, Wang W, Li H, Zhao Y, Han Y, Gao W, Jin X, Wang G, Zhang Z, Li G, Zhang Q, Zhang X, Ma H, Zhang C. Young Patients With Colorectal Cancer Have Higher Early Mortality but Better Long-Term Survival. Clin Transl Gastroenterol 2022; 13:e00543. [PMID: 36579781 PMCID: PMC9780114 DOI: 10.14309/ctg.0000000000000543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/03/2022] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION To define the prognosis of colorectal cancer (CRC) in young patients and to compare their postoperative treatment with that of older patients. METHODS This multicenter study enrolled 5,457 patients with primary CRC who underwent surgical resection. The overall survival (OS), clinicopathologic characteristics, and postoperative treatment of 253 young patients aged 18-44 years and 5,204 older patients aged 44-80 years were analyzed. RESULTS The OS rate was 77.1% for young and 74.2% for older patients (P = 0.348). Landmark analysis showed a significant difference in survival between young and older patients, with 63.8% of deaths among young patients being within 25 months of surgery compared with 42.4% among older patients (P = 0.002). Among those who survived more than 25 months, young patients had significantly better survival than older patients (P = 0.009). Multivariable analysis of young patients revealed that the tumor location, perineural invasion, and stage were associated with poor survival within 25 months; after this period, stage was the only prognostic marker. Young patients were more likely to receive chemotherapy, particularly multiagent regimens. For young patients, no significant difference in OS was found based on the chemotherapy regimen, regardless of disease stage (II, III, or IV, all P > 0.05). In addition, unlike in older patients, no difference in OS was found in young patients regardless of the drug regimen administered (all P > 0.05). DISCUSSION Young-onset CRC may have a unique disease biology that warrants further research and therapy development.
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Affiliation(s)
- Shuyuan Wang
- School of Medicine, Nankai University, Tianjin, China
| | - Zhen Yuan
- School of Medicine, Nankai University, Tianjin, China
| | - Kemin Ni
- School of Medicine, Nankai University, Tianjin, China
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Yixiang Zhan
- School of Medicine, Nankai University, Tianjin, China
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Xuanzhu Zhao
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhaoce Liu
- School of Medicine, Nankai University, Tianjin, China
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Yanfei Liu
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ben Yi
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Sizhen Lai
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xin Yin
- School of Medicine, Nankai University, Tianjin, China
| | - Xingyu Zhou
- School of Medicine, Nankai University, Tianjin, China
| | - Yuqi Wang
- School of Medicine, Nankai University, Tianjin, China
| | - Hangyu Ping
- School of Medicine, Nankai University, Tianjin, China
| | - Ran Xin
- School of Medicine, Nankai University, Tianjin, China
| | - Wenhong Wang
- Department of Radiology, Tianjin Union Medical Center, Tianjin, China
| | - Hongzhou Li
- Department of Endoscopy, Tianjin Union Medical Center, Tianjin, China
| | - Yuanshun Zhao
- Department of Endoscopy, Tianjin Union Medical Center, Tianjin, China
| | - Youkui Han
- Department of General Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Weifeng Gao
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Xinlei Jin
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Guihua Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zili Zhang
- Tianjin Third Central Hospital, Tianjin, China
| | - Guoxun Li
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Tianjin Institute of Coloproctology, Tianjin, China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
| | - Qinghuai Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Tianjin Institute of Coloproctology, Tianjin, China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Tianjin Institute of Coloproctology, Tianjin, China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
| | - Hong Ma
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Chunze Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Tianjin Institute of Coloproctology, Tianjin, China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
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Castelo M, Sue-Chue-Lam C, Paszat L, Scheer AS, Hansen BE, Kishibe T, Baxter NN. Clinical Delays and Comparative Outcomes in Younger and Older Adults with Colorectal Cancer: A Systematic Review. Curr Oncol 2022; 29:8609-8625. [PMID: 36421332 PMCID: PMC9689013 DOI: 10.3390/curroncol29110679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Outcome disparities between adults <50 with colorectal cancer (CRC) and older adults may be explained by clinical delays. This study synthesized the literature comparing delays and outcomes between younger and older adults with CRC. Databases were searched until December 2021. We included studies published after 1990 reporting delay in adults <50 that made comparisons to older adults. Comparisons were described narratively and stage between age groups was meta-analyzed. 39 studies were included representing 185,710 younger CRC patients and 1,422,062 older patients. Sixteen delay intervals were compared. Fourteen studies (36%) found significantly longer delays among younger adults, and nine (23%) found shorter delays among younger patients. Twelve studies compared time from symptom onset to diagnosis (N younger = 1538). Five showed significantly longer delays for younger adults. Adults <50 years also had higher odds of advanced stage (16 studies, pooled OR for Stage III/IV 1.76, 95% CI 1.52-2.03). Ten studies compared time from diagnosis to treatment (N younger = 171,726) with 4 showing significantly shorter delays for younger adults. All studies showing longer delays for younger adults examined pre-diagnostic intervals. Three studies compared the impact of delay on younger versus older adult. One showed longer delays were associated with advanced stage and worse survival in younger but not older adults. Longer delays among younger adults with CRC occur in pre-diagnostic intervals.
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Affiliation(s)
- Matthew Castelo
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Colin Sue-Chue-Lam
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Lawrence Paszat
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 1P5, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Adena S. Scheer
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 1P5, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON M5B 1W8, Canada
| | - Bettina E. Hansen
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Teruko Kishibe
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON M5B 1W8, Canada
| | - Nancy N. Baxter
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 1P5, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON M5B 1W8, Canada
- School of Population and Global Health, University of Melbourne, 207 Bouverie St. Level 5, Melbourne, VIC 3010, Australia
- Correspondence: ; Tel.: +61-43-531-3313
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Significant Rise of Colorectal Cancer Incidence in Younger Adults and Strong Determinants: 30 Years Longitudinal Differences between under and over 50s. Cancers (Basel) 2022; 14:cancers14194799. [PMID: 36230718 PMCID: PMC9563745 DOI: 10.3390/cancers14194799] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: There is evidence in the recent literature that the incidence patterns of colorectal cancer (CRC) have changed considerably over the years, tending to rise rapidly in individuals under 50 years old compared with those over 50 years. The current study aimed to assess the incidence of CRC in Crete from 1992−2021 and compare them among younger and older adults. (2) Methods: Data on malignant neoplasms of colon, rectosigmoid junction, and rectum have been extracted from the database of the Regional Cancer Registry of Crete. (3) Results: The number of these cases for the period 1992−2021 was 3857 (n = 2895 colon and n = 962 rectum). The mean age-specific incidence rate (ASpIR/100,000/year) of colon cancer patients <50 years was 7.2 (95% CI 5.1−9.7), while for patients ≥50 years the ASpIR was 149 (95% CI 146.2−153.4). ASpIR presented a 29.6% increase from 2001 to 2011 in the age group of 20−34 years and further increase is expected from 2022−2030 (projected change, 42.8%). The main risk factors were the pack years (p = 0.01), alcohol consumption (0.02), and farmer occupation (0.04), especially during 2012−2021. (4) Conclusions: We confirmed an increased incidence of CRC in young adults <50 in a European population with low cancer incidence in the past and a worrisome prediction for the near future. The observed trends clearly indicate that starting CRC screening at an earlier age may be essential.
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Castelo M, Sue-Chue-Lam C, Paszat L, Kishibe T, Scheer AS, Hansen BE, Baxter NN. Time to diagnosis and treatment in younger adults with colorectal cancer: A systematic review. PLoS One 2022; 17:e0273396. [PMID: 36094913 PMCID: PMC9467377 DOI: 10.1371/journal.pone.0273396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background The incidence of colorectal cancer is rising in adults <50 years of age. As a primarily unscreened population, they may have clinically important delays to diagnosis and treatment. This study aimed to review the literature on delay intervals in patients <50 years with colorectal cancer (CRC), and explore associations between longer intervals and outcomes. Methods MEDLINE, Embase, and LILACS were searched until December 2, 2021. We included studies published after 1990 reporting any delay interval in adults <50 with CRC. Interval measures and associations with stage at presentation or survival were synthesized and described in a narrative fashion. Risk of bias was assessed using the Newcastle-Ottawa Scale, Institute of Health Economics Case Series Quality Appraisal Checklist, and the Aarhus Checklist for cancer delay studies. Results 55 studies representing 188,530 younger CRC patients were included. Most studies used primary data collection (64%), and 47% reported a single center. Sixteen unique intervals were measured. The most common interval was symptom onset to diagnosis (21 studies; N = 2,107). By sample size, diagnosis to treatment start was the most reported interval (12 studies; N = 170,463). Four studies examined symptoms onset to treatment start (total interval). The shortest was a mean of 99.5 days and the longest was a median of 217 days. There was substantial heterogeneity in the measurement of intervals, and quality of reporting. Higher-quality studies were more likely to use cancer registries, and be population-based. In four studies reporting the relationship between intervals and cancer stage or survival, there were no clear associations between longer intervals and adverse outcomes. Discussion Adults <50 with CRC may have intervals between symptom onset to treatment start greater than 6 months. Studies reporting intervals among younger patients are limited by inconsistent results and heterogeneous reporting. There is insufficient evidence to determine if longer intervals are associated with advanced stage or worse survival. Other This study’s protocol was registered with the Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42020179707).
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Affiliation(s)
- Matthew Castelo
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Colin Sue-Chue-Lam
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Lawrence Paszat
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Teruko Kishibe
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Adena S. Scheer
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Bettina E. Hansen
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nancy N. Baxter
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
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Jarrar MS, Barka M, Ben Abdessalem MZ, Toumi R, Mrabet S, Abdessayed N, Mraidha MH, Sghaier A, Hamila F, Youssef S. East-central Tunisian patients with colorectal adenocarcinoma: a comparative study of the clinicopathological features between patients under 50 years of age and older patients. LA TUNISIE MEDICALE 2022; 100:534-540. [PMID: 36571742 PMCID: PMC9703909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Colorectal cancer is a major public health problem. In younger patients, its incidence continues to rise and its prognosis appears to be worse. Its treatment is based on curative surgery associated with neo-adjuvant and adjuvant therapies. AIM To describe the clinical and pathological characteristics of colorectal cancers in young patients. METHODS In this monocentric cohort study, we retrospectively analyzed the clinicopathological features in colorectal cancer patients who underwent treatment from 2002 to 2014. Data of younger (group A, ≤50years) vs older (group B, >50years) patients were compared. RESULTS Two hundred and sixty-six patients met inclusion and non-inclusion criteria. The younger and older groups consisted respectively of 25.2% and 74.8% of patients. Both groups were comparable regarding the symptom presentation and duration. Synchronous tumors were more frequent amongst the group A (10.7% vs 1.0%, p = 0.024). Preoperative staging showed a higher frequency of tumors classified as advanced stage (stages III and IV) in the group A (p = 0.001). The patients of group A were diagnosed with a higher proportion of poorly differentiated or undifferentiated adenocarcinomas (13.4% vs 3.5%, p = 0.005), the mucinous character was also more frequent in the group A (28.4%). According to the pTNM (tumor, nodes and metastases) classification, tumors were more advanced in the group A than in group B (80.6% vs 48.7%, p <0.001). CONCLUSION This study revealed that colorectal adenocarcinomas in the younger patients, compared to the older ones, were more aggressive with a higher proportion of poorly differentiated or undifferentiated adenocarcinomas, more often mucin production and more advanced tumors.
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Affiliation(s)
- Mohamed Salah Jarrar
- 1. Department of General and Digestive Surgery - Farhat Hached University Hospital - Sousse / Faculty of Medicine of Sousse
| | - Malek Barka
- 1. Department of General and Digestive Surgery - Farhat Hached University Hospital - Sousse / Faculty of Medicine of Sousse
| | - Mohamed Zied Ben Abdessalem
- 1. Department of General and Digestive Surgery - Farhat Hached University Hospital - Sousse / Faculty of Medicine of Sousse
| | - Radhouane Toumi
- 2. Intensive Care Unit - Farhat Hached University Hospital - Sousse / Faculty of Medicine of Sousse
| | - Soumaya Mrabet
- 3. Department of gastroenterology- Farhat Hached University Hospital - Sousse / Faculty of Medicine of Sousse
| | - Nihed Abdessayed
- 4. Department of pathology- Farhat Hached University Hospital- Sousse/ Faculty of Medicine of Sousse
| | - Mohamed Hedi Mraidha
- 1. Department of General and Digestive Surgery - Farhat Hached University Hospital - Sousse / Faculty of Medicine of Sousse
| | - Asma Sghaier
- 1. Department of General and Digestive Surgery - Farhat Hached University Hospital - Sousse / Faculty of Medicine of Sousse
| | - Fehmi Hamila
- 1. Department of General and Digestive Surgery - Farhat Hached University Hospital - Sousse / Faculty of Medicine of Sousse
| | - Sabri Youssef
- 1. Department of General and Digestive Surgery - Farhat Hached University Hospital - Sousse / Faculty of Medicine of Sousse
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9
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Liu C, Wang T, Yang J, Zhang J, Wei S, Guo Y, Yu R, Tan Z, Wang S, Dong W. Distant Metastasis Pattern and Prognostic Prediction Model of Colorectal Cancer Patients Based on Big Data Mining. Front Oncol 2022; 12:878805. [PMID: 35530362 PMCID: PMC9074728 DOI: 10.3389/fonc.2022.878805] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/23/2022] [Indexed: 12/24/2022] Open
Abstract
Aims This study aimed to investigate the distant metastasis pattern from newly diagnosed colorectal cancer (CRC) and also construct and validate a prognostic nomogram to predict both overall survival (OS) and cancer-specific survival (CSS) of CRC patients with distant metastases. Methods Primary CRC patients who were initially diagnosed from 2010 to 2016 in the SEER database were included in the analysis. The independent risk factors affecting the OS, CSS, all-cause mortality, and CRC-specific mortality of the patients were screened by the Cox regression and Fine–Gray competitive risk model. The nomogram models were constructed to predict the OS and CSS of the patients. The reliability and accuracy of the prediction model were evaluated by consistency index (C-index) and calibration curve. The gene chip GSE41258 was downloaded from the GEO database, and differentially expressed genes (DEGs) were screened by the GEO2R online tool (p < 0.05, |logFC|>1.5). The Kyoto Encyclopedia of Genes and Genomes (KEGG) Pathway and Gene Ontology (GO) annotation and String website were used for enrichment analysis and protein–protein interaction (PPI) analysis of DEGs, respectively, and Cytoscape software was used to construct PPI network and screen function modules and hub genes. Results A total of 57,835 CRC patients, including 47,823 without distant metastases and 10,012 (17.31%) with metastases, were identified. Older age, unmarried status, poorly differentiated or undifferentiated grade, right colon site, larger tumor size, N2 stage, more metastatic sites, and elevated carcinoembryonic antigen (CEA) might lead to poorer prognosis (all p < 0.01). The independent risk factors of OS and CSS were included to construct a prognosis prediction model for predicting OS and CSS in CRC patients with distant metastasis. C-index and calibration curve of the training group and validation group showed that the models had acceptable predictive performance and high calibration degree. Furthermore, by comparing CRC tissues with and without liver metastasis, 158 DEGs and top 10 hub genes were screened. Hub genes were mainly concentrated in liver function and coagulation function. Conclusion The big data in the public database were counted and transformed into a prognostic evaluation tool that could be applied to the clinic, which has certain clinical significance for the formulation of the treatment plan and prognostic evaluation of CRC patients with distant metastasis.
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Affiliation(s)
- Chuan Liu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ting Wang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiahui Yang
- Department of Geriatric, West China Hospital of Sichuan University, Chengdu, China
| | - Jixiang Zhang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shuchun Wei
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yingyun Guo
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Rong Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zongbiao Tan
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shuo Wang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Weiguo Dong
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
- *Correspondence: Weiguo Dong,
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10
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Kim TW, Hong HK, Lee C, Kim S, Lee WY, Yun SH, Kim HC, Huh JW, Park YA, Joung JG, Park WY, Cho YB. The role of PDGFRA as a therapeutic target in young colorectal cancer patients. J Transl Med 2021; 19:446. [PMID: 34702313 PMCID: PMC8546951 DOI: 10.1186/s12967-021-03088-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/24/2021] [Indexed: 12/13/2022] Open
Abstract
Background Young patients with colorectal cancer (CRC) exhibit poor prognoses compared to older patients due to the difficulty in early diagnosis and treatment. However, the underlying molecular characteristics are still unclear. Methods We conducted a comprehensive analysis of 49 CRC patients without hereditary CRC using the whole-exome and RNA sequencing with tumor and matched normal samples. A total of 594 TCGA samples and 4 patient-derived cells were utilized for validation. Results Consensus molecular subtype 4 (CMS4) (53.85%) and CMS2 (38.46%) were enriched in the young (≤ 40 years) and old (> 60 years) age groups, respectively. A CMS4-associated gene, platelet-derived growth factor receptor α (PDGFRA), was significantly upregulated in young patients with CRC (FC = 3.21, p = 0.0001) and was negatively correlated with age (p = 0.0001, R = − 0.526). Moreover, PDGFRA showed a positive co-expression with metastasis-related genes in young CRC patients. In vitro validation confirmed that young patient-derived cells (PDCs) showed an enriched expression of PDGFRA compared to old PDCs and a reduced proliferation rate by knockdown of PDGFRA. Furthermore, young CRC patients were more sensitive to regorafenib, a PDGFRA-targeting drug, than old CRC patients. Conclusions Our study suggests that CRC in young patients is associated with CMS4 and PDGFRA. In addition, PDGFRA may serve potential of novel therapeutic strategies and represent a predictive biomarker of response to regorafenib for young CRC patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-021-03088-7.
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Affiliation(s)
- Tae Won Kim
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Hye Kyung Hong
- Samsung Biomedical Research Institute, Seoul, Republic of Korea
| | - Chung Lee
- Samsung Genome Institute, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Sunmin Kim
- Samsung Genome Institute, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Woo Yong Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Seong Hyeon Yun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Hee Cheol Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jung Wook Huh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Yoon Ah Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Je-Gun Joung
- Samsung Genome Institute, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. .,Department of Biomedical Science, CHA University, Pocheon-si, South Korea.
| | - Woong-Yang Park
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea. .,Samsung Genome Institute, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. .,Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Yong Beom Cho
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea. .,Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. .,Department of Biopharmaceutical Convergence, Sunkyunkwan University, Seoul, Korea.
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11
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Saizul Z, Siti-Azrin AH, Zakaria AD, Hassan A, Abdul Rahman WFW, Jalil NAC. BRAF V600E and Mismatch Repair Proteins Expression in Sporadic Young-onset Colorectal Cancer in Kelantan, Malaysia. Oman Med J 2021; 36:e284. [PMID: 34367685 PMCID: PMC8311123 DOI: 10.5001/omj.2021.83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 10/17/2020] [Indexed: 12/02/2022] Open
Abstract
Objectives We sought to determine the immunohistochemistry expression of mismatch repair (MMR) and BRAF V600E proteins in sporadic young-onset colorectal cancer (CRC) and their association with clinicopathological features in the Kelantan population. Methods This was a cross-sectional study of sporadic young-onset CRC over 11 years from 1 January 2006 to 31 December 2017 in Kelantan. Formalin-fixed paraffin-embedded tissue blocks were immunohistochemically stained with antibodies for MMR (MLH1, MSH2, MSH6, and PMS2) and BRAF V600E. These expressions were correlated with clinicopathological parameters. Results Our patient sample included 31 patients with a mean age of 31.5 years. More than half (61.3%) of the patients were women. The majority presented with abdominal pain (41.9%), and 71.0% had a tumor located on the right side of the colon, with 83.9% being moderately differentiated adenocarcinoma. The majority of patients presented at stage IV (54.8%). The most frequent pattern was all MMR protein expressions, which constituted patients in the microsatellite stable group (64.5%). Nine (29.0%) were microsatellite instability (MSI-high), and two (6.5%) were MSI-low. Positive BRAF V600E expression was observed in 83.9% of patients. Only histopathological subtypes revealed a significant association with BRAF V600E positive expression (p = 0.015). Conclusions The majority of sporadic young-onset CRC presented with abdominal pain and advanced cancer stage. Most were microsatellite stable, and most cases showed positive expressions in all MMR markers and BRAF V600E by immunohistochemistry method. This finding will pave the way for further research on this disease.
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Affiliation(s)
- Zubaidah Saizul
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.,Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Ab Hamid Siti-Azrin
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.,Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Andee Dzulkarnaen Zakaria
- Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.,Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Aniza Hassan
- Jabatan Patologi, Hospital Raja Perempuan Zainab II in Kota Bharu, Kelantan, Malaysia
| | - Wan Faiziah Wan Abdul Rahman
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.,Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Nur Asyilla Che Jalil
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.,Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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12
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Habib R, Burgess NG, Bourke MJ, Wong M, Wilcken N, Toh J, El-Khoury T, Pathma-Nathan N, Ctercteko G, Jayamohan J, Micklethwaite K, Nagrial A. Outcomes of young patients diagnosed with locally advanced rectal cancer. J Gastrointest Oncol 2021; 12:592-601. [PMID: 34012652 DOI: 10.21037/jgo-20-300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background The incidence of rectal cancer is higher in the older population. In developed nations, there has been a rise in incidence in young onset colorectal cancer (CRC). We examined the outcomes of locally advanced rectal cancer (LARC) in younger patients (yRC) compared with older patients, using a retrospective audit. Methods All cases of LARC referred to two tertiary referral cancer centres in Western Sydney were examined. Patient demographics, presenting symptoms, treatment, relapse free survival (RFS), overall survival (OS) and progression free survival (PFS) were obtained. Under 50 years old was used as the cut-off age for defining yRC. Results All 145 consecutive patients were treated for LARC, including 28 in the yRC and 117 in the older patient group. Median follow-up was 54 months. yRC were more likely to complete neoadjuvant therapy (100% vs. 86%; P=0.032) and to undergo more extensive surgical procedures (24% vs. 2%, P<0.0001). yRC were more likely to have microsatellite high (MSI) tumours (30% vs. 4.7%; P=0.003). yRC demonstrated significantly poorer RFS compared with the standard group (HR 2.79; median RFS 4.67 vs. 16.02 months; P=0.023). In the relapsed setting, yRC had poorer PFS compared with the standard group (median PFS 2.66 vs. 9.70, P=0.006, HR 3.04). A difference in OS was also seen between the two groups, with yRC demonstrating poorer OS (median OS 40.46 vs. 58.26 months, HR 3.48, P=0.036). Conclusions Patients under 50 years with LARC are more likely to have MSI tumours with a more aggressive disease course and poorer RFS, PFS and OS. Initiatives to improve early detection of these patients may improve outcomes. Further research is necessary to understand this disease and optimise its treatment.
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Affiliation(s)
- Rosemary Habib
- Westmead Clinical School, The University of Sydney, Sydney, Australia.,Department of Medical Oncology, Westmead Hospital, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Nicholas G Burgess
- Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Michael J Bourke
- Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Mark Wong
- Department of Medical Oncology, Westmead Hospital, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Blacktown hospital, Blacktown Cancer and Haematology Centre, Sydney, New South Wales, Australia
| | - Nicholas Wilcken
- Department of Medical Oncology, Westmead Hospital, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - James Toh
- Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Toufic El-Khoury
- Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,University of Notre Dame, Sydney, New South Wales, Australia
| | - Nimalan Pathma-Nathan
- Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Grahame Ctercteko
- Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Jayasingham Jayamohan
- Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Radiation Oncology, Westmead Hospital, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia
| | - Kenneth Micklethwaite
- Westmead Clinical School, The University of Sydney, Sydney, Australia.,Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,The Westmead Institute for Medical Research, Westmead, New South Wales, Australia.,Sydney Cellular Therapies Laboratory, Blood and Bone Marrow Transplant Unit, Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - Adnan Nagrial
- Department of Medical Oncology, Westmead Hospital, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Blacktown hospital, Blacktown Cancer and Haematology Centre, Sydney, New South Wales, Australia
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13
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Cai H, Zhang Y, Liu X, Jiang W, Chen Z, Li S, Guan G. Association of age and cause-special mortality in patients with stage I/ II colon cancer: A population-based competing risk analysis. PLoS One 2020; 15:e0240715. [PMID: 33064784 PMCID: PMC7567365 DOI: 10.1371/journal.pone.0240715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 10/02/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE This study aimed to determine the probability and prognostic factors of colon cancer-specific mortality (CCSM) and noncancer-specific mortality (NCSM) for patients with stage I/II colon cancer and evaluate the association of age on cause-specific mortality. MATERIALS AND METHODS From Surveillance, Epidemiology, and End Results (SEER) database, we identified 33152 patients with stage I/II colon cancer undergoing surgery between 2004 and 2011. The cumulative incidence of CCSM and NCSM was calculated, and competing risk analysis was performed to investigate prognostic factors for cause-specific mortality. RESULTS In patients <50, 50-75, and >75 years of age, 5-year cumulative incidence of CCSM was 5.7%, 7.8%, and 16.1%, respectively (overall, 10.6%); 5-year cumulative incidence of NCSM was 2.2%, 7.1%, and 26.9%, respectively (overall, 13.8%). The probability of CCSM and NCSM increased with advanced age. The 5-year cumulative incidence of CCSM was higher than NCSM in patients <50 years of age, whereas lower in patients >75 years of age. The probability of CCSM and NCSM was similar in patients 50-75 years of age. Competing-risk multivariable analysis demonstrated that increasing age was a strong predictor of CCSM (per year increase, SHR 1.03,95% confidence interval [CI]: 1.03-1.04). Age was most predictive of NCSM: (per year increase, SHR 1.08, 95% CI: 1.08-1.08). CONCLUSION Age was significantly associated with an increased cumulative incidence of CCSM and NCSM of patients with stage I/II colon cancer underwent surgery. NCSM was a significant competing event and should be adequately considered when performing survival analysis.
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Affiliation(s)
- Huajun Cai
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yiyi Zhang
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xing Liu
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Weizhong Jiang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhifen Chen
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Shoufeng Li
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guoxian Guan
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- * E-mail:
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14
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Sandhu GS, Anders R, Blatchford P, Walde A, Alexis Leal, King G, Leong S, Davis SL, Purcell WT, Goodman KA, Schefter T, Michelle Cowan, Herter W, Meguid C, Weiss R, Marsh M, Brown M, Vogel J, Birnbaum E, Ahrendt S, Gleisner A, Schulick R, Chiaro MD, McCarter M, Patel SG, Messersmith WA, Lieu CH. High incidence of prolonged rectal bleeding and advanced stage cancer in early-onset colorectal cancer patients. COLORECTAL CANCER 2020. [DOI: 10.2217/crc-2020-0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: We examined characteristics of early-onset colorectal cancer (CRC) patients to identified factors, which may lead to earlier diagnosis. Materials & methods: This is a retrospective study with inclusion criteria: CRC diagnosed between 2012 and 2018 and age at diagnosis <50 years. Results: A total of 209 patients were included (mean age 41.8 years). Of those patients 42.5% had rectal cancer and 37.8% were stage IV at initial diagnosis. Of patients with data available for rectal bleeding history (n = 173), 50.8% presented with rectal bleeding and median time from onset of bleeding to diagnosis was 180 days (interquartile range 60–365), with longer duration noted in advanced cancer. Conclusion: Prolonged rectal bleeding history was noted in a significant proportion of early-onset CRC patients, with longer duration of rectal bleeding noted in stage IV patients. Patients and primary care physicians should be made aware of this finding in order to facilitate timely referral for diagnostic workup.
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Affiliation(s)
- Gurprataap Singh Sandhu
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rebekah Anders
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Amy Walde
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Alexis Leal
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Gentry King
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Stephen Leong
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sarah Lindsey Davis
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - William T Purcell
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Karyn A Goodman
- Department of Radiation Oncology, Mount Sinai Hospital, New York City, NY 10029, USA
| | - Tracey Schefter
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Michelle Cowan
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Whitney Herter
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Cheryl Meguid
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Reed Weiss
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Megan Marsh
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Matthew Brown
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jon Vogel
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Elisa Birnbaum
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Steven Ahrendt
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ana Gleisner
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Richard Schulick
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Marco Del Chiaro
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Martin McCarter
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Swati G Patel
- Division of Gastroenterology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Wells A Messersmith
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Christopher H Lieu
- Department of Medicine, Division of Hematology & Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
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15
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Ghodssi-Ghassemabadi R, Hajizadeh E, Kamian S, Mahmoudi M. Clinicopathological features and survival of colorectal cancer patients younger than 50 years: a retrospective comparative study. J Egypt Natl Canc Inst 2019; 31:6. [PMID: 32372124 DOI: 10.1186/s43046-019-0006-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/10/2019] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a disease of old age, but its incidence has been rising among younger population compared to older ones. Nevertheless, there is a controversy over survival of younger patients compared to the older ones. Therefore, in the current study, we investigated the clinicopathological features and survival of the younger (< 50 years) versus older (≥ 50 years) CRC patients. RESULTS The younger and older groups consisted of 39.4% and 60.6% of patients, respectively. Both age groups were comparable regarding the symptom presentation and duration, and pre-operative carcinoembryonic antigen (CEA). The younger patients were diagnosed with a higher proportion of poorly differentiated (14.7% vs. 8.3%; p < 0.001) and more advanced tumors (53.2% vs. 45.9%; p = 0.266). The rectum tumor site was significantly more common among the younger patients (p = 0.021). The overall survival (OS) (p = 0.278), the cancer-specific survival (CSS) (p = 0.233), and the disease-free survival (DFS) (p = 0.497) did not differ significantly between the two groups. Based on Cox regression model, elevated pre-operative CEA level (HR = 1.41; 95%CI of 1.01-1.97), advanced tumor stage (6.06; 95%CI of 3.03-12.15), and poorly differentiated tumor (HR = 1.69; 95%CI of 1.05-2.71) were associated with decreased survival. CONCLUSIONS The younger patients did not have poor prognosis compared to the older ones despite having an advanced tumor stage and a poor tumor differentiation.
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Affiliation(s)
| | - Ebrahim Hajizadeh
- Department of Biostatistics, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Shaghayegh Kamian
- Shahid Beheshti University of Medical Sciences, Imam Hossein Hospital, Tehran, Iran
| | - Mahmood Mahmoudi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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16
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Wang Y, Yang L, Zhou M, Shen L, Zhang J, Deng W, Liang L, Hu R, Yang W, Yao Y, Zhang Z. Disparities in survival for right-sided vs. left-sided colon cancers in young patients: a study based on the Surveillance, Epidemiology, and End Results database (1990-2014). Cancer Manag Res 2018; 10:1735-1747. [PMID: 29983593 PMCID: PMC6027707 DOI: 10.2147/cmar.s163302] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose To investigate whether young patients exhibit different characteristics and survival according to tumor location and stage using data from the Surveillance, Epidemiology, and End Results (SEER) database. Patients and methods Young patients (20–49 years old) with stage I–III colon cancers were identified from the SEER program from 1990 to 2014. Kaplan–Meier survival analysis and Cox proportional hazards regression were used to analyze the data. Subset analyses were also done among different age and stage subgroups. Results Of 8197 patients, 3709 (45.2%) had right-sided colon cancers (RCCs). Patients with RCCs were more likely to be male, to be younger, and to have more poorly differentiated and more advanced tumors. The Kaplan–Meier survival curves and univariate survival models revealed that left-sided colon cancers (LCCs) had lower mortality for all stages combined and stage III, but higher mortality for stage II, compared with right-sided tumors. However, multivariate Cox regression models showed no significant survival differences by location for all patients (adjusted hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.86–1.05; P=0.34) or for stage I (adjusted HR, 1.47; 95% CI, 0.82–2.63; P=0.20). Stage II left-sided cancers had higher mortality (adjusted HR, 1.24; 95% CI, 1.00–1.54; P=0.048), whereas stage III left-sided cancers had lower mortality (adjusted HR, 0.86; 95% CI, 0.77–0.97; P=0.01). For 20- to 39-year-old patients, a significant difference was only found in stage II disease, with a higher mortality for left-sided tumors (adjusted HR, 1.82; 95% CI, 1.12–2.97; P=0.02). However, for 40- to 49-year-old patients, a significant difference was only found in stage III disease, with a lower mortality for left-sided tumors (adjusted HR, 0.83; 95% CI, 0.72–0.95; P=0.008). Conclusion In patients younger than 50 years, there were no significant differences in mortality between RCCs and LCCs for all stages combined after adjusting for multiple clinicopathological features. However, RCCs had lower mortality in stage II (especially in 20- to 39-year-old patients) and higher mortality in stage III (especially in 40- to 49-year-old patients).
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Affiliation(s)
- Yaqi Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Lifeng Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Menglong Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Lijun Shen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Jing Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Weijuan Deng
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Liping Liang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Ran Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Wang Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Ye Yao
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
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Zhao H, Chen D, Cao R, Wang S, Yu D, Liu Y, Jiang Y, Xu M, Luo J, Wang S. Alcohol consumption promotes colorectal carcinoma metastasis via a CCL5-induced and AMPK-pathway-mediated activation of autophagy. Sci Rep 2018; 8:8640. [PMID: 29872080 PMCID: PMC5988731 DOI: 10.1038/s41598-018-26856-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 05/21/2018] [Indexed: 12/11/2022] Open
Abstract
There is a definite relationship between alcohol consumption and colorectal cancer (CRC) development. We investigated effect of alcohol consumption on CRC patients’ progression and prognosis by utilizing epidemiological data and found patients with alcohol consumption increased risks of tumor-node-metastasis (TNM), organ metastasis and poorer prognosis. Because their tumor tissues displayed increased expression of C-C chemokine ligand 5 (CCL5), we hypothesized CCL5 might participate in cancer progression in such patients. Ethanol increased the secretion of CCL5 in two CRC cell lines, HT29 and DLD-1. Treatment with CCL5 directly increased migratory ability of these cells, whereas neutralization or knockdown of CCL5 can partially block alcohol-stimulated migration. We further investigated underlying mechanism of CCL5-induced migration. Our results indicated that effects of CCL5 on migration are mediated by the ability of CCL5 to induce autophagy, a cellular process known to be critical for migration. Using high-throughput sequencing and western blotting, we found induction of autophagy by CCL5 takes place via AMPK pathway. Aforementioned ethanol increases CCL5 secretion, CCL5 activates autophagy through AMPK pathway, and autophagy increases migration was confirmed by experiments with autophagy or AMPK inhibitors. To sum up, our study demonstrates that chronic alcohol consumption may promote metastasis of CRC through CCL5-induced autophagy.
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Affiliation(s)
- Haodong Zhao
- Department of Pathophysiology, School of Basic Medicine, Anhui Medical University, Hefei, 230032, China
| | - Danlei Chen
- Department of Pathophysiology, School of Basic Medicine, Anhui Medical University, Hefei, 230032, China
| | - Rui Cao
- Department of Pathophysiology, School of Basic Medicine, Anhui Medical University, Hefei, 230032, China
| | - Shiqing Wang
- Department of Pathophysiology, School of Basic Medicine, Anhui Medical University, Hefei, 230032, China
| | - Dandan Yu
- Department of Pathophysiology, School of Basic Medicine, Anhui Medical University, Hefei, 230032, China
| | - Yakun Liu
- Department of Pathophysiology, School of Basic Medicine, Anhui Medical University, Hefei, 230032, China
| | - Yu Jiang
- Department of Pathophysiology, School of Basic Medicine, Anhui Medical University, Hefei, 230032, China
| | - Mei Xu
- Department of Pharmacology and Nutritional Sciences, University of Kentucky College of Medicine, Lexington, Kentucky, 40536, USA
| | - Jia Luo
- Department of Pharmacology and Nutritional Sciences, University of Kentucky College of Medicine, Lexington, Kentucky, 40536, USA.
| | - Siying Wang
- Department of Pathophysiology, School of Basic Medicine, Anhui Medical University, Hefei, 230032, China.
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18
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Law JH, Koh FHX, Wang S, Tan KK. Curative treatment for metastatic colorectal cancer in the young population: is it worth it? J Gastrointest Oncol 2018; 10:61-67. [PMID: 30788160 DOI: 10.21037/jgo.2018.09.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background A significant proportion of patients with colorectal cancer (CRC) presents with metastatic disease. In younger patients, a more aggressive approach is often adopted in an attempt to achieve cure and improve survival. The aim of this paper is to review the management and outcomes of young patients with metastatic CRC. Methods All patients under 50 years diagnosed with CRC in a single institution from January 2007 to December 2015 were reviewed. Patient demographics, details of their treatments, progress and outcomes of treatment were collected for our review. Results There were 154 newly diagnosed CRC patients who were <50 years old during the study period. Thirty-three patients (21.4%) had stage IV disease on presentation. Seventeen (51.5%) of these 33 patients were treated with curative intent; 9 (52.9%) of whom underwent upfront surgical resection alone while the remaining 8 (47.1%) patients had neoadjuvant therapy followed by surgical resection. Among the 16 patients who were treated with palliative intent, 9 (56.3%) had surgery while 7 (43.7%) had definitive chemo- or radio-therapy. There was no significant difference in the median survival of patients treated with curative and palliative intent (29 vs. 24 months, P=0.140). Conclusions Young CRC patients with stage IV disease typically survive for 2 years upon diagnosis. Those who were treated and underwent surgery with curative intent have a slightly longer but not statistically significant median survival than those treated with palliative intent. The role of aggressive treatment in these young patients with metastatic patients merits further evaluation.
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Affiliation(s)
- Jia Hao Law
- Division of Colorectal Surgery, Department of General Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Frederick Hong Xiang Koh
- Division of Colorectal Surgery, Department of General Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Shi Wang
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ker Kan Tan
- Division of Colorectal Surgery, Department of General Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
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Inoki K, Sakamoto T, Takamaru H, Sekiguchi M, Yamada M, Nakajima T, Matsuda T, Taniguchi H, Sekine S, Kanemitsu Y, Ohe Y, Saito Y. Predictive relevance of lymphovascular invasion in T1 colorectal cancer before endoscopic treatment. Endosc Int Open 2017; 5:E1278-E1283. [PMID: 29218320 PMCID: PMC5718905 DOI: 10.1055/s-0043-117952] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 06/26/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND AND AIM The depth of tumor invasion is currently the only reliable predictive risk factor for lymph node metastasis before endoscopic treatment for colorectal cancer. However, the most important factor to predict lymph node metastasis has been suggested to be lymphovascular invasion rather than the depth of invasion. Thus, the aim of this study was to investigate the predictive relevance of lymphovascular invasion before endoscopic treatment. METHODS The data on pT1 colorectal cancers that were resected endoscopically or surgically from 2007 to 2015 were retrospectively reviewed. The cases were categorized into two groups: positive or negative for lymphovascular invasion. The following factors were evaluated by univariate and multivariate analyses: age and sex of the patients; location, size, and morphology of the lesion; and depth of invasion. RESULTS The positive and negative groups included 229 and 457 cases, respectively. Younger age ( P < 0.01), smaller lesion size ( P = 0.01), non-LST (LST: laterally spreading tumor) ( P < 0.01), presence of depression ( P < 0.01), and pT1b ( P < 0.01) were associated with lymphovascular invasion. In multivariate analysis, younger age (comparing patients aged ≤ 64 years with those aged > 65 years, OR, 1.81; 95 %CI, 1.29 - 2.53), presence of depression (OR, 1.97; CI, 1.40 - 2.77), non-LST features (OR, 1.50; CI, 1.04 - 2.15), and pT1b (OR, 3.08; CI, 1.91 - 4.97) were associated with lymphovascular invasion. CONCLUSION Younger age, presence of depression, T1b, and non-LST are associated with lymphovascular invasion. Therefore, careful pathological diagnosis and surveillance are necessary for lesions demonstrating any of these four factors.
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Affiliation(s)
- Kazuya Inoki
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan,Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan,Corresponding author Taku Sakamoto, MD National Cancer Center Hospital5-1-1 TsukijiChuo-kuTokyo104-0045Japan+81-3-35423815
| | | | - Masau Sekiguchi
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Masayoshi Yamada
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takeshi Nakajima
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hirokazu Taniguchi
- Pathology and Clinical Laboratory Division, National Cancer Center Hospital, Tokyo, Japan
| | - Shigeki Sekine
- Pathology and Clinical Laboratory Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihide Kanemitsu
- Colorectal Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yuichiro Ohe
- Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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20
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Yang J, Du XL, Li S, Wu Y, Lv M, Dong D, Zhang L, Chen Z, Wang B, Wang F, Shen Y, Li E, Yi M, Yang J. The risk and survival outcome of subsequent primary colorectal cancer after the first primary colorectal cancer: cases from 1973 to 2012. BMC Cancer 2017; 17:783. [PMID: 29166866 PMCID: PMC5700626 DOI: 10.1186/s12885-017-3765-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/08/2017] [Indexed: 12/27/2022] Open
Abstract
Background Among colorectal cancer (CRC) survivors, how the prior tumor location affects the risk of subsequent primary colorectal cancer (SPCRC) and the outcome of those suffering from SPCRC remain unknown. Methods CRC cases diagnosed from 1973 to 2012 were screened for SPCRC development using the Surveillance, Epidemiology, and End Results database. The relative risk of SPCRC was estimated using the standardized incidence ratio. Survivals were analyzed using the Kaplan–Meier and Cox regression model. Results The overall risk of SPCRC increased by 27% in CRC survivors compared to that of the general population. The risk increased in patients with both prior right colon cancer (RCC) and left colon cancer (LCC), and was concentrated in the first 5 years after the prior diagnosis, and among young patients. Among the 6701 SPCRC patients identified, patients with prior RCC were more likely to be elderly, female, and with more low or undifferentiated disease than those with prior LCC or rectal cancer (ReC). The overall survivals differed by both prior tumor location (P < 0.0001) and age (P < 0.0001), and the difference by tumor location remained significant when adjusted or stratified by any other potential prognostic factor except age. The cancer specific survivals differed by age (P < 0.0001) rather than by prior tumor location (P = 0.455). Conclusions The overall risk of SPCRC increased among patients with both prior RCC and LCC, but not among those with ReC. The different survival outcomes in CRC survivors suffering from SPCRC were largely explained by the patient age but not by the prior tumor location. Electronic supplementary material The online version of this article (10.1186/s12885-017-3765-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jiao Yang
- Departments of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi Province, People's Republic of China
| | - Xianglin L Du
- Division of Epidemiology & Disease Control, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shuting Li
- Departments of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi Province, People's Republic of China
| | - Yinying Wu
- Departments of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi Province, People's Republic of China
| | - Meng Lv
- Departments of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi Province, People's Republic of China
| | - Danfeng Dong
- Departments of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi Province, People's Republic of China
| | - Lingxiao Zhang
- Departments of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi Province, People's Republic of China
| | - Zheling Chen
- Departments of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi Province, People's Republic of China
| | - Biyuan Wang
- Departments of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi Province, People's Republic of China
| | - Fan Wang
- Departments of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi Province, People's Republic of China
| | - Yanwei Shen
- Departments of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi Province, People's Republic of China
| | - Enxiao Li
- Departments of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi Province, People's Republic of China
| | - Min Yi
- Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jin Yang
- Departments of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi Province, People's Republic of China.
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Manjelievskaia J, Brown D, McGlynn KA, Anderson W, Shriver CD, Zhu K. Chemotherapy Use and Survival Among Young and Middle-Aged Patients With Colon Cancer. JAMA Surg 2017; 152:452-459. [PMID: 28122072 DOI: 10.1001/jamasurg.2016.5050] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Treatment options for patients with young-onset colon cancer remain to be defined and their effects on prognosis are unclear. Objective To investigate receipt of adjuvant chemotherapy by age category (18-49, 50-64, and 65-75 years) and assess whether age differences in chemotherapy matched survival gains among patients diagnosed as having colon cancer in an equal-access health care system. Design, Setting, and Participants This cohort study was based on linked and consolidated data from the US Department of Defense's Central Cancer Registry and Military Heath System medical claims databases. There were 3143 patients aged 18 to 75 years with histologically confirmed primary colon adenocarcinoma diagnosed between 1998 and 2007. This study was conducted from December 2015 to August 2016. Exposures Patients who underwent surgery and postoperative systemic chemotherapy. Main Outcomes and Measures The primary outcome measure of the study was overall survival of patients who only received surgery and those who received both surgery and postoperative systemic chemotherapy. Results Of the 3143 patients, 1841 were men (58.6%). Young (18-49 years) and middle-aged (50-64 years) patients were 2 to 8 times more likely to receive postoperative systemic chemotherapy compared with older patients (65-75 years) across all tumor stages. Middle-aged patients with stage I (odds ratio, 5.04; 95% CI, 2.30-11.05) and stage II (odds ratio, 2.42; 95% CI, 1.58-3.72) disease were more likely to receive postoperative chemotherapy compared with older patients. Both groups were more likely to receive multiagent chemotherapy than were older patients (patients aged 18-49 years: odds ratio, 2.48; 95% CI, 1.42-4.32 and patients aged 50-64 years: odds ratio, 2.66; 95% CI, 1.70-4.18). Among patients who received surgery and postoperative systemic chemotherapy, no significant differences were observed in survival among age groups (the 95% CIs of hazard ratios included 1 for young and middle-aged patients compared with older patients for all tumor stages). Conclusions and Relevance In an equal-access health care system, we found potential overuse of chemotherapy among young and middle-aged adults with colon cancer. The addition of postoperative systemic chemotherapy did not result in matched survival improvement.
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Affiliation(s)
- Janna Manjelievskaia
- John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Derek Brown
- John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - William Anderson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Craig D Shriver
- John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, Maryland3Uniformed Services University, Bethesda, Maryland
| | - Kangmin Zhu
- John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, Maryland3Uniformed Services University, Bethesda, Maryland
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Zhao L, Bao F, Yan J, Liu H, Li T, Chen H, Li G. Poor prognosis of young patients with colorectal cancer: a retrospective study. Int J Colorectal Dis 2017; 32:1147-1156. [PMID: 28389779 DOI: 10.1007/s00384-017-2809-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE The present study aimed to explore the survival outcomes of patients with colorectal cancer (CRC) aged 35 years and younger. METHODS This retrospective cohort study included a total of 995 patients with CRC treated between January 2003 and September 2011. The patients were assorted into the young (aged 18-35 years) and older (aged 36-75 years) groups. The clinical characteristics and survival outcomes of the patients in the young group were compared with those of the patients in the older group for evaluation. RESULTS Compared with the older group, a significantly higher number of patients in the young group had right-sided colon cancer (30.9 vs. 19.6%, P = 0.026), high histologic grade tumor (14.7 vs. 6.4%, P = 0.021), and stage III disease (50.0 vs. 35.5%, P = 0.016). In stage III disease, compared with the older group, the patients in the young group had worse survival outcome in terms of 5-year overall survival (OS, P = 0.007), cancer-specific survival (CSS, P = 0.010), and disease-free survival (DFS, P = 0.039). Multivariate analysis revealed that age ≤35 years was an independent risk factor in terms of 5-year OS (hazard ratio [HR] = 1.68; 95% confidence interval [CI]: 1.12-2.54; P = 0.012), CSS (HR = 1.74; 95% CI: 1.15-2.65; P = 0.009), and DFS (HR = 1.58; 95% CI: 1.06-2.35; P = 0.024). CONCLUSIONS The young patients with CRC aged 35 years and younger had worse prognosis compared with older patients, especially for stage III disease.
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Affiliation(s)
- Liying Zhao
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Feng Bao
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China.,Department of General Surgery, Mianyang Central Hospital, Mianyang, People's Republic of China
| | - Jun Yan
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Hao Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Tingting Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Hao Chen
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China.
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Overall Survival of Elderly Patients Having Surgery for Colorectal Cancer Is Comparable to Younger Patients: Results from a South Asian Population. Gastroenterol Res Pract 2017; 2017:9670512. [PMID: 28811822 PMCID: PMC5547707 DOI: 10.1155/2017/9670512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/20/2017] [Accepted: 06/08/2017] [Indexed: 01/18/2023] Open
Abstract
Introduction There has been a continuous debate on whether elderly patients with colorectal cancer (CRC) fair worse. The aim of this study is to assess the thirty-day mortality (TDM) and overall survival (OS) of elderly patients undergoing surgery for CRC. Method OS between two groups (≥70 versus <70 years) having surgery for CRC was analyzed. Demographics, tumour characteristics, and serological markers were considered as independent factors. Multivariable analysis was done using the Cox proportional hazard model. We also compared overall survival in the elderly versus those <60 and <50 years. Results 477 patients, 160 elderly (55% male; median age 75, range 70–89) and 317 younger patients (49% male; median age 55, range 16 to 69), were studied. Overall survival in CRC patients ≥70 is comparable to <70 (P = 0.45) and <60 years (P = 0.08). Poor OS was observed in the ≥70 versus <50 years (P = 0.03). TDM in the elderly was poor (P < 0.05). Postoperative cardiac complication was the only determinant affecting survival in the elderly (P = 0.01). Conclusion OS in elderly CRC patients having surgery is not worse compared to <70 and <60 years although the TDM was higher. Postoperative cardiac complications significantly affected OS in those ≥70 compared to those <50 years. Chronological age alone should not negatively influence surgical decision-making in the elderly.
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Baghestani AR, Moamer S, Pourhoseingholi MA, Khadem Maboudi AA, Ghoreshi B, Zali MR. Demographic and Pathological Predictors of Colorectal Cancer Survival in Competing Risk Model, Using Generalized Weibull Distribution. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2017; 10. [DOI: 10.5812/ijcm.7352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Mesli SN, Regagba D, Tidjane A, Benkalfat M, Abi-Ayad C. [Analysis of histoprognostic factors for the non metastatic rectal cancer in a west Algerian series of 58 cases]. Pan Afr Med J 2016; 24:5. [PMID: 27583069 PMCID: PMC4992382 DOI: 10.11604/pamj.2016.24.5.8580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 03/17/2016] [Indexed: 11/11/2022] Open
Abstract
Introduction L'objectif de notre travail est d'analyser les facteurs histo-pronostiques des cancers du rectum non métastatique opérés au service de chirurgie «A» de Tlemcen à ouest Algérien durant une période de six ans. Méthodes Etude rétrospective de 58 patients qui avait un adénocarcinome rectal. Le critère de jugement était la survie. Les paramètres étudiés, le sexe, l’âge, stade tumoral, et les récidives tumorales. Résultats L’âge moyen était de 58 ans. Avec 52% d'hommes contre 48% femmes avec sex-ratio (1,08). Le siège tumoral était: moyen rectum avec 41,37%, 34,48% au bas rectum et dans 24,13% au haut rectum. La classification TNM avec 17,65% au stade I, 18,61% au stade II, 53, 44% au stade III et 7,84% au stade IV. La survie médiane globale était de 40 mois ±2,937 mois. La survie en fonction du stade tumoral, le stade III et IV avait un faible taux de survie (19%) a 3 ans contre le stade I, II avait un taux de survie de (75%) (P = 0,000) (IC 95%). Les patients avec récidives tumorales avaient un taux de survie faible à 3 ans par rapport à ceux n'ayant pas eu de récidive (30,85% Vs 64,30% P = 0,043). Conclusion Dans cette série, l’étude uni varié des différents facteurs pronostiques conditionnant la survie n'a permis de retenir que trois facteurs influençant la survie, à savoir la taille tumorale, le stade, et les récidives tumorales. En analyse multi variée en utilisant le modèle Cox un seul facteur été retenu la récidive tumorale.
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Affiliation(s)
- Smain Nabil Mesli
- Service de Chirurgie Viscérale «A», Centre Hospitalier Universitaire Tlemcen, Laboratoire de Recherche N°39, Faculté de Médecine, Tlemcen, Algérie
| | - Derbali Regagba
- Service d'Epidémiologie Centre Hospitalier Universitaire, Oran, Algérie
| | - Anisse Tidjane
- Service de Chirurgie Hépatobiliaire et Greffe du Foie EHU- 1er Novembre 1954, Oran, Algérie
| | - Mokhtar Benkalfat
- Laboratoire de Chirurgie Expérimentale N°39, Faculté de Médecine, Tlemcen, Algérie
| | - Chakib Abi-Ayad
- Service de Chirurgie Viscérale «A», Centre Hospitalier Universitaire Tlemcen, Laboratoire de Recherche N°39, Faculté de Médecine, Tlemcen, Algérie
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Deen KI, Silva H, Deen R, Chandrasinghe PC. Colorectal cancer in the young, many questions, few answers. World J Gastrointest Oncol 2016; 8:481-488. [PMID: 27326317 PMCID: PMC4909449 DOI: 10.4251/wjgo.v8.i6.481] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/11/2016] [Accepted: 03/16/2016] [Indexed: 02/05/2023] Open
Abstract
At a time where the incidence of colorectal cancer, a disease predominantly of developed nations, is showing a decline in those 50 years of age and older, data from the West is showing a rising incidence of this cancer in young individuals. Central to this has been the 75% increase in rectal cancer incidence in the last four decades. Furthermore, predictive data based on mathematical modelling indicates a 124 percent rise in the incidence of rectal cancer by the year 2030 - a statistic that calls for collective global thought and action. While predominance of colorectal cancer (CRC) is likely to be in that part of the large bowel distal to the splenic flexure, which makes flexible sigmoidoscopic examination an ideal screening tool, the cost and benefit of mass screening in young people remain unknown. In countries where the incidence of young CRC is as high as 35% to 50%, the available data do not seem to indicate that the disease in young people is one of high red meat consuming nations only. Improvement in our understanding of genetic pathways in the aetiology of CRC, chiefly of the MSI, CIN and CIMP pathway, supports the notion that up to 30% of CRC is genetic, and may reflect a familial trait or environmentally induced changes. However, a number of other germline and somatic mutations, some of which remain unidentified, may play a role in the genesis of this cancer and stand in the way of a clear understanding of CRC in the young. Clinically, a proportion of young persons with CRC die early after curative surgery, presumably from aggressive tumour biology, compared with the majority in whom survival after operation will remain unchanged for five years or greater. The challenge in the future will be to determine, by genetic fingerprinting or otherwise, those at risk of developing CRC and the determinants of survival in those who develop CRC. Ultimately, prevention and early detection, just like for those over 50 years with CRC, will determine the outcome of CRC in young persons. At present, aside from those with an established familial tendency, there is no consensus on screening young persons who may be at risk. However, increasing awareness of this cancer in the young and the established benefit of prevention in older persons, must be a message that should be communicated with medical students, primary health care personnel and first contact doctors. The latter constitutes a formidable challenge.
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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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Effect of Age on Survival Outcome in Operated and Non-Operated Patients with Colon Cancer: A Population-Based Study. PLoS One 2016; 11:e0147383. [PMID: 26789841 PMCID: PMC4720357 DOI: 10.1371/journal.pone.0147383] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/04/2016] [Indexed: 12/12/2022] Open
Abstract
Objective To know the effect of age on survival outcome in operated and non-operated patients with colon cancer. Methods From the Surveillance, Epidemiology, and End Results database, we identified 123,356 patients with colon cancer who were diagnosed between 1996 and 2005, grouped them as older or younger than 40 years and analyzed their 5-year cancer-specific survival (CSS) data, along with some risk factors, using Kaplan–Meier methods and multivariable Cox regression models. Results The younger group had significantly higher pathological grades (P<0.001), more mucinous and signet-ring histology (P<0.001), advanced AJCC stage (P<0.001), and were more likely to undergo surgery (P<0.001). For surgically treated patients, age did not significantly affect 5-year CSS (younger: 66.7%; older: 67.3%; P = 0.86). Further analysis showed that age was an independent prognostic factor in stage I–IV disease (stage I: P = 0.001; P<0.001 for stages II–IV, in both uni- and multivariate analyses), but not for patients with unknown disease stage (P = 0.52). For non-surgically treated patients, age significantly affected 5-year CSS (younger: 16.2%; older: 12.9%; P<0.001) in univariate analysis; and was an independent prognostic factor (P<0.001) in multivariate analysis. Conclusion The CSS rate for younger CC patients was at least as high as for older patients, although they presented with higher proportions of unfavorable factors and more advanced disease.
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ZENG CHUNYAN, ZHAN YISHAN, HUANG JUN, CHEN YOUXIANG. MicroRNA-7 suppresses human colon cancer invasion and proliferation by targeting the expression of focal adhesion kinase. Mol Med Rep 2015; 13:1297-303. [DOI: 10.3892/mmr.2015.4643] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 08/19/2015] [Indexed: 11/06/2022] Open
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Tsai JH, Liau JY, Lin YL, Tseng LH, Lin LI, Yeh KH, Jeng YM. Frequent BRAF mutation in early-onset colorectal cancer in Taiwan: association with distinct clinicopathological and molecular features and poor clinical outcome. J Clin Pathol 2015; 69:319-25. [PMID: 26500331 DOI: 10.1136/jclinpath-2015-203335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/30/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Occurrence of early-onset colorectal cancer (EOCRC) under the age of 30 is very rare and the molecular characteristics are poorly understood. A low BRAF mutation rate has been noted in several studies of EOCRC from Western countries. AIMS To determine the clinicopathological and molecular features of EOCRCs in Taiwan. METHODS KRAS/BRAF gene mutation, mismatch repair protein immunohistochemistry, microsatellite instability and CpG island methylation phenotype analyses were examined to determine the molecular characteristics of EOCRC. RESULTS Sixty-six patients with EOCRC at our hospital between 2000 and 2012 were studied. BRAF mutation was detected in 11 of the 59 tumours analysed (19%) and the rate was significantly higher than the overall BRAF mutation rate of colorectal cancer in patients older than 30 years (p<0.001). Clinically, 9 of 11 patients with BRAF-mutated tumours presented with advanced-stage diseases and they presented significantly more frequently with stage IV disease than those with BRAF wild-type tumours (p=0.042). Histologically, BRAF mutation was associated with a poorly differentiated histology, a serrated precursor polyp and focal signet ring cell differentiation (p=0.042, 0.008 and 0.008, respectively). None of the BRAF-mutated tumours was mismatch repair protein-deficient and/or microsatellite instability-high. Overall survival of patients with BRAF-mutated tumours was significantly worse than that of patients with BRAF wild-type tumours, despite adjustment for the disease stages and tumour differentiation. CONCLUSIONS BRAF mutation was frequent in EOCRCs in Taiwan and was associated with distinct clinicopathological and molecular features.
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Affiliation(s)
- Jia-Huei Tsai
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan Graduate Institute of Pathology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jau-Yu Liau
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan Graduate Institute of Pathology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Lin Lin
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Li-Hui Tseng
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
| | - Liang-In Lin
- Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kun-Huei Yeh
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yung-Ming Jeng
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan Graduate Institute of Pathology, College of Medicine, National Taiwan University, Taipei, Taiwan
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Mohd Suan MA, Tan WL, Soelar SA, Ismail I, Abu Hassan MR. Intestinal obstruction: predictor of poor prognosis in colorectal carcinoma? Epidemiol Health 2015; 37:e2015017. [PMID: 25868638 PMCID: PMC4459110 DOI: 10.4178/epih/e2015017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/30/2015] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The goal of this study was to assess the relationship between intestinal obstruction and the prognosis of colorectal carcinoma. METHODS Data pertaining to 4,501 colorectal carcinoma patients were extracted from the national colorectal registry and analysed. Survival analysis was performed using the Kaplan-Meier method. The log-rank test was used to compare the survival rate between patients with intestinal obstruction and those without intestinal obstruction. The p-values<0.05 were considered to indicate statistical significance. Simple Cox proportional hazards regression analysis was used to estimate the crude hazard ratio of mortality from colorectal cancer. RESULTS Intestinal obstruction was reported in more than 13% of patients. The 3-year survival rate after treatment was 48.3% (95% confidence interval [CI], 43.9 to 52.8) for patients with intestinal obstruction (n=593) and 54.9% (95% CI, 53.1 to 56.6) for patients without intestinal obstruction (n=3,908). The 5-year survival rate for patients with intestinal obstruction was 37.3% (95% CI, 31.9 to 42.8), which was lower than that of patients without intestinal obstruction (45.6%; 95% CI, 43.5 to 47.7). After adjusting the hazard ratio for other prognostic variables, intestinal obstruction had a statistically significant negative correlation with the survival rate of colorectal cancer patients, with an adjusted hazard ratio of 1.22 (p=0.008). CONCLUSIONS The presence of intestinal obstruction is associated with a lower survival rate among colorectal cancer patients.
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Affiliation(s)
| | - Wei Leong Tan
- Clinical Research Center, Sultanah Bahiyah Hospital, Kedah, Malaysia
| | | | - Ibtisam Ismail
- Clinical Research Center, Sultanah Bahiyah Hospital, Kedah, Malaysia
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Udare A, Sable N, Kumar R, Thakur M, Juvekar S. Solitary osseous metastasis of rectal carcinoma masquerading as osteogenic sarcoma on post-chemotherapy imaging: a case report. Korean J Radiol 2015; 16:175-9. [PMID: 25598687 PMCID: PMC4296267 DOI: 10.3348/kjr.2015.16.1.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 10/28/2014] [Indexed: 11/30/2022] Open
Abstract
Solitary metastases from colorectal carcinoma in the absence of hepatic or pulmonary metastases are rare. These can have a diverse imaging appearance, particularly after chemotherapy. It is important identify patients with solitary skeletal metastases, as they have a better prognosis than those with multiple skeletal or visceral metastases. We describe an unusual case of a solitary metastasis to the femur in a case of colon carcinoma that went undiagnosed and later presented with imaging features of osteogenic sarcoma.
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Affiliation(s)
- Amar Udare
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai 400012, India
| | - Nilesh Sable
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai 400012, India
| | - Rajiv Kumar
- Department of Pathology, Tata Memorial Hospital, Mumbai 400012, India
| | - Meenakshi Thakur
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai 400012, India
| | - Shashikant Juvekar
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai 400012, India
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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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Prognostic value of 18 F-FDG uptake by regional lymph nodes on pretreatment PET/CT in patients with resectable colorectal cancer. Eur J Nucl Med Mol Imaging 2014; 41:2203-11. [DOI: 10.1007/s00259-014-2840-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 06/16/2014] [Indexed: 01/13/2023]
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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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Li Q, Cai G, Li D, Wang Y, Zhuo C, Cai S. Better long-term survival in young patients with non-metastatic colorectal cancer after surgery, an analysis of 69,835 patients in SEER database. PLoS One 2014; 9:e93756. [PMID: 24699879 PMCID: PMC3974782 DOI: 10.1371/journal.pone.0093756] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 03/07/2014] [Indexed: 12/13/2022] Open
Abstract
Objective To compare the long-term survival of colorectal cancer (CRC) in young patients with elderly ones. Methods Using Surveillance, Epidemiology, and End Results (SEER) population-based data, we identified 69,835 patients with non-metastatic colorectal cancer diagnosed between January 1, 1988 and December 31, 2003 treated with surgery. Patients were divided into young (40 years and under) and elderly groups (over 40 years of age). Five-year cancer specific survival data were obtained. Kaplan-Meier methods were adopted and multivariable Cox regression models were built for the analysis of long-term survival outcomes and risk factors. Results Young patients showed significantly higher pathological grading (p<0.001), more cases of mucinous and signet-ring histological type (p<0.001), later AJCC stage (p<0.001), more lymph nodes (≥12 nodes) dissected (p<0.001) and higher metastatic lymph node ratio (p<0.001). The 5-year colorectal cancer specific survival rates were 78.6% in young group and 75.3% in elderly group, which had significant difference in both univariate and multivariate analysis (P<0.001). Further analysis showed this significant difference only existed in stage II and III patients. Conclusions Compared with elderly patients, young patients with colorectal cancer treated with surgery appear to have unique characteristics and a higher cancer specific survival rate although they presented with higher proportions of unfavorable biological behavior as well as advanced stage disease.
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Affiliation(s)
- Qingguo Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Guoxiang Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Dawei Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Yuwei Wang
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Changhua Zhuo
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
- * E-mail:
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Clinical features and outcome of sporadic colorectal carcinoma in young patients: a cross-sectional analysis from a developing country. ISRN ONCOLOGY 2014; 2014:461570. [PMID: 25006505 PMCID: PMC4004039 DOI: 10.1155/2014/461570] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 03/12/2014] [Indexed: 01/03/2023]
Abstract
Background. Early onset colorectal carcinoma (CRC) is rare and has been hypothesized to be a biologically and clinically distinct entity personifying aggressive disease and worse survival. Methods. Data for 131 patients was collected by retrospective chart review. Cox proportional hazard model was used to compute prevalence ratios and 95% confidence intervals. Results. Early onset sporadic CRC accounted for 32% of all CRC treated in the specified time period. The mean age was 33.3 ± 7.9 years and the male to female ratio was 2 : 1. Colon and rectal cancers accounted for 55% and 45% of patients, respectively. 96% of rectal carcinoma patients received appropriate therapy as opposed to 65% of colon cancers. On multivariable analysis, appropriate reception of therapy (PR 4.99; 95% CI, 1.21–20.6) and signet ring morphology (PR 2.40; 95% CI, 1.33–4.32) were significantly associated with rectal cancers as opposed to colon cancer. Kaplan-Meier analysis revealed a trend towards inferior survival for rectal carcinoma 2 years after diagnosis. Conclusion.A high prevalence of early onset CRC was noted in the study. A trend towards inferior survival was seen in patients with rectal cancer. This finding raises the possibility of rectal carcinoma being an aggressive subset of young CRC.
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Ahmed S, Howel D, Debrah S. The influence of age on the outcome of treatment of elderly patients with colorectal cancer. J Geriatr Oncol 2014; 5:133-40. [PMID: 24495704 DOI: 10.1016/j.jgo.2013.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 08/22/2013] [Accepted: 12/31/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVES We investigated factors associated with post-operative mortality rates in those aged ≥60, and in particular, the relative survival of age bands within this group. METHODS Secondary analysis of a large comprehensive cohort of the elderly treated for colorectal cancer in the North of England during 1998-2003. We investigated seven risk factors associated with 30-day and 6-month post-operative mortality from colorectal surgery. RESULTS 6083 patients aged ≥60 underwent colorectal cancer surgery. Approximately 8% had died within 30 days of surgery and 17% had died within 6 months. Thirty-day mortality was greater in the elderly (80 years+) compared to the young-old (60-69 years) (adjusted OR: 3.2, 95% CI 2.4 to 4.4). There was neither a significant difference between the proportions offered curative resections across the age-groups, nor was there a significant association between intent of surgery and 30-day mortality. Six-month mortality rose with age, but the association was stronger in those having curative surgery (adjusted OR: 3.8, 95% CI 2.8 to 5.2) than palliative surgery (adjusted OR: 1.5, 95% CI 1.1 to 2.1). Mortality from emergency surgery at 6-months was particularly high in elderly females. CONCLUSIONS This large population study adds more weight to the findings that age itself is a major risk factor in the outcome of colorectal surgery in elderly and that 30-day mortality underestimates the longer-term outcome in this age group. There was no significant association between radical resections and 30-day mortality in elderly patients compared to the younger age groups; however, a disproportionately higher mortality at 6 months was seen in elderly female patients.
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Affiliation(s)
- Sohail Ahmed
- Darlington Memorial Hospital, Hollyhurst Road, Darlington DL3-6HX, UK.
| | - Denise Howel
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle-upon-Tyne NE2-4AX, UK.
| | - Samuel Debrah
- Darlington Memorial Hospital, Darlington DL3-6HX, UK.
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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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Sun Y, Shen S, Tang H, Xiang J, Peng Y, Tang A, Li N, Zhou W, Wang Z, Zhang D, Xiang B, Ge J, Li G, Wu M, Li X. miR-429 identified by dynamic transcriptome analysis is a new candidate biomarker for colorectal cancer prognosis. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2013; 18:54-64. [PMID: 24237355 DOI: 10.1089/omi.2012.0132] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Colorectal cancer (CRC) is a common malignant gastrointestinal cancer. Efforts for preventive and personalized medicine have intensified in the last decade with attention to novel forms of biomarkers. In the present study, microRNA and genetic analyses were performed in tandem for differential transcriptome profiling between primary tumors with or without nodes or distant metastases. Serial Test Cluster (STC) analysis demonstrated that 20 genes and two microRNAs showed distinctive expression patterns associated with the tumor, node, and metastasis (TNM) stage. The selected target genes were characterized by GO and Pathway analysis. A microRNA-target gene network analysis showed that miR-429 resided in the center of the network, indicating that miR-429 might serve important roles in the development of CRC. Real-time PCR and tissue microarrays showed that miR-429 had a dynamic expression pattern during the CRC progression stage, and was significantly downregulated in stage II and stage III clinical progression. The low expression of miR-429 was correlated with poor prognosis for CRC. Taken together, miR-429 warrant further clinical translation research as a candidate biomarker for CRC prognosis. Additional downstream targets and attendant gene function also need to be discerned to design a sound critical path to personalized medicine for persons susceptible to, or diagnosed with CRC.
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Affiliation(s)
- Yingnan Sun
- 1 Department of Gastroenterology, The Third Xiangya Hospital, Central South University , Changsha, Hunan, People's Republic of China
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Myers EA, Feingold DL, Forde KA, Arnell T, Jang JH, Whelan RL. Colorectal cancer in patients under 50 years of age: A retrospective analysis of two institutions' experience. World J Gastroenterol 2013; 19:5651-5657. [PMID: 24039357 PMCID: PMC3769901 DOI: 10.3748/wjg.v19.i34.5651] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 05/09/2013] [Accepted: 06/04/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the epidemiological characteristics of colorectal cancer (CRC) in patients under 50 years of age across two institutions.
METHODS: Records of patients under age 50 years of age who had CRC surgery over a 16 year period were assessed at two institutions. The following documents where reviewed: admission notes, operative notes, and discharge summaries. The main study variables included: age, presenting symptoms, family history, tumor location, operation, stage/differentiation of disease, and post operative complications. Stage of disease was classified according to the American Joint Committee on Cancer TNM staging system: tumor depth; node status; and metastases.
RESULTS: CRC was found in 180 patients under age 50 years (87 females, 93 males; mean age 41.4 ± 6.2 years). Young patients accounted for 11.2% of cases during a 6 year period for which the full data set was available. Eight percent had a 1st degree and 12% a 2nd degree family CRC history. Almost all patients (94%) were symptomatic at diagnosis; common symptoms included: bleeding (59%), obstruction (9%), and abdominal/rectal pain (35%). Evaluation was often delayed and bleeding frequently attributed to hemorrhoids. Advanced stage CRC (Stage 3 or 4) was noted in 53% of patients. Most tumors were distal to the splenic flexure (77%) and 39% involved the rectum. Most patients (95%) had segmental resections; 6 patients had subtotal/total colectomy. Poorly differentiated tumors were noted in 12% and mucinous lesions in 19% of patients of which most had Stage 3 or 4 disease. Twenty-two patients (13%) developed recurrence and/or progression of disease to date. Three patients (ages 42, 42 and 49 years) went on to develop metachronous primary colon cancers within 3 to 4 years of their initial resection.
CONCLUSION: CRC was common in young patients with no family history. Young patients with symptoms merit a timely evaluation to avoid presentation with late stage CRC.
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Banai Z, Bartók Á, Renteria-Delgádó RZ. [Colorectal carcinoma under the age of 50 years]. Orv Hetil 2013; 154:1345-51. [PMID: 23955970 DOI: 10.1556/oh.2013.29687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Colorectal cancer is the second most common cause of cancer related death in Hungary. AIM The authors examined retrospectively the ratio and the clinical course of patients under the age of 50 years operated by themselves between January, 2006 and May, 2012. METHOD During this period of time 667 patients underwent surgery for colorectal carcinoma and 44 (6.6%) were less than 50 years old. 22.2% of the operations were performed for emergency reasons. The surgical technique, TNM stage, differentiation state and localization of the tumours were analyzed as well as the histological types with unfavourable prognosis. In order to analyse risk factors a questionnaire was sent to patients of young age group. RESULTS The majority of patients, including those under 50 years of age were diagnosed as having TNM stages III and IV. Only half of the patients returned the questionnaire. CONCLUSIONS Due to a relatively low response rate, the importance of risk factors for colorectal carcinoma in patients under 50 years of age remains to be further investigated.
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Affiliation(s)
- Zoltán Banai
- Toldy Ferenc Kórház és Rendelőintézet Sebészeti Osztály Cegléd Törteli út 1-3. 2700
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Aryaie M, Roshandel G, Semnani S, Asadi-Lari M, Aarabi M, Vakili MA, Kazemnejhad V, Sedaghat SM, Solaymani-Dodaran M. Predictors of Colorectal Cancer Survival in Golestan, Iran: A Population-based Study. Epidemiol Health 2013; 35:e2013004. [PMID: 23807907 PMCID: PMC3691365 DOI: 10.4178/epih/e2013004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 04/23/2013] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES We aimed to investigate factors associated with colorectal cancer survival in Golestan, Iran. METHODS We used a population based cancer registry to recruit study subjects. All patients registered since 2004 were contacted and data were collected using structured questionnaires and trained interviewers. All the existing evidences to determine the stage of the cancer were also collected. The time from first diagnosis to death was compared in patients according to their stage of cancer using the Kaplan-Meir method. A Cox proportional hazard model was built to examine their survival experience by taking into account other covariates. RESULTS Out of a total of 345 subjects, 227 were traced. Median age of the subjects was 54 and more than 42% were under 50 years old. We found 132 deaths among these patients, 5 of which were non-colorectal related deaths. The median survival time for the entire cohort was 3.56 years. A borderline significant difference in survival experience was detected for ethnicity (log rank test, p=0.053). Using Cox proportional hazard modeling, only cancer stage remained significantly associated with time of death in the final model. CONCLUSIONS Colorectal cancer occurs at a younger age among people living in Golestan province. A very young age at presentation and what appears to be a high proportion of patients presenting with late stage in this area suggest this population might benefit substantially from early diagnoses by introducing age adapted screening programs.
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Affiliation(s)
- Mohammad Aryaie
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
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Raman R, Kotapalli V, Adduri R, Gowrishankar S, Bashyam L, Chaudhary A, Vamsy M, Patnaik S, Srinivasulu M, Sastry R, Rao S, Vasala A, Kalidindi N, Pollack J, Murthy S, Bashyam M. Evidence for possible non-canonical pathway(s) driven early-onset colorectal cancer in India. Mol Carcinog 2012; 53 Suppl 1:E181-6. [PMID: 23168910 DOI: 10.1002/mc.21976] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/08/2012] [Accepted: 10/12/2012] [Indexed: 12/13/2022]
Abstract
Two genetic instability pathways viz. chromosomal instability, driven primarily by APC mutation induced deregulated Wnt signaling, and microsatellite instability (MSI) caused by mismatch repair (MMR) inactivation, together account for >90% of late-onset colorectal cancer (CRC). Our understanding of early-onset sporadic CRC is however comparatively limited. In addition, most seminal studies have been performed in the western population and analyses of tumorigenesis pathway(s) causing CRC in developing nations have been rare. We performed a comparative analysis of early and late-onset CRC from India with respect to common genetic aberrations including Wnt, KRAS, and p53 (constituting the classical CRC progression sequence) in addition to MSI. Our results revealed the absence of Wnt and MSI in a significant proportion of early-onset as against late-onset CRC in India. In addition, KRAS mutation frequency was significantly lower in early-onset CRC indicating that a significant proportion of CRC in India may follow tumorigenesis pathways distinct from the classical CRC progression sequence. Our study has therefore revealed the possible existence of non-canonical tumorigenesis pathways in early-onset CRC in India.
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Affiliation(s)
- Ratheesh Raman
- Laboratory of Molecular Oncology, Centre for DNA Fingerprinting and Diagnostics (CDFD), Nampally, Hyderabad, India
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Bouassida M, Feidi B, Mroua B, Chtourou MF, Sassi S, Chebbi F, Bouchtili S, Mighri MM, Touinsi H, Azzouz MM, Sassi S. Histopathologic characteristics and short-term outcomes of colorectal cancer in young Tunisian patients: one center's experience. Pan Afr Med J 2012; 12:10. [PMID: 22826734 PMCID: PMC3396856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 04/03/2012] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Colorectal carcinoma (CRC) is generally a disease of persons older than 40 years. Concerning younger patients, controversies still exist regarding features and prognosis of CRC. We performed this study to characterise CRC in young patients (≤ 40 years) as well as to evaluate short-term outcome in comparison with older patients (>40 years) with CRC. METHODS Clinical and histopathological parameters of 40 patients aged 40 years or less were compared with 240 patients aged more than 40 years. RESULTS In young patients, the minority suffered from hereditary cancer syndromes (0.4%). Furthermore, up to 87% of young patients denied any cancers in their families. Compared with older patients, young patients had more mucinous adenocarcinomas (32.5% vs. 11.5%; p=0.02), more venous invasion (p=0.021), more perineural invasion (p=0.028). For grading (p=0.42), lymphatic invasion (p=0.17) and tumor sites (p=0.46), no significant differences between young and older patients were found. Young patients had less post operative morbidity (p=0.039), less post operative mortality (0.029). Young and older patients had the same overall 1-year survival rates (p=0.24), and the same cancer-related 1-year survival rates (p=0.1). CONCLUSION Tunisian patients present with colorectal cancer at a more advanced stage of the disease at younger ages compared to developed countries. The early detection of CRC followed by a sufficient oncologic treatment is crucial regardless of age. It is mandatory for all patients with suspicious symptoms to undergo early adequate diagnoses.
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Affiliation(s)
- Mahdi Bouassida
- Mohamed Thahar Maamouri Hospital, Nabeul, Tunisia,Corresponding author: Mahdi Bouassida, Department of Surgery, Mohamed Thahar Maamouri Hospital, 8000 Mrazga, Nabeul, Tunisia
| | - Bilel Feidi
- Mohamed Thahar Maamouri Hospital, Nabeul, Tunisia
| | - Bassem Mroua
- Mohamed Thahar Maamouri Hospital, Nabeul, Tunisia
| | | | - Selim Sassi
- Mohamed Thahar Maamouri Hospital, Nabeul, Tunisia
| | - Fathi Chebbi
- Mohamed Thahar Maamouri Hospital, Nabeul, Tunisia
| | | | | | | | | | - Sadok Sassi
- Mohamed Thahar Maamouri Hospital, Nabeul, Tunisia
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