McLaren Regional Medical Center, Flint, MI
Shams Aziz Mistry , Harish Madala , Charles Chacko , Neha Jain , Jill Gernand , Madan L. Arora , Radhika Kakarala
Background: Colon cancer is detected at a later stage in younger patients (YP) (< 50 years) probably due to lack of screening in this age group. There has been an increased incidence of colon cancer (1.6%) in YP, but they are underrepresented in research studies. The aim of our study is to compare characteristics of colon cancer and survival outcome in YPs (18-49 years) vs older patients (>50) using the Surveillance, Epidemiology, and End Results (SEER) database. Methods: Using the SEER database (1991-2010), we reviewed patients > 18 years of age with colon cancer. Multivariate Cox regression analysis was used to evaluate risk adjusted outcomes and to predict the hazard of dying. Kaplan Meier method was used to estimate the survival function. Results: We included 375,443 patients in our study. YPs with colon carcinoma were more likely to be African American (15.7% vs 10.6%; p<0.001), Hispanic (13.5% vs 6.7%; p<0.001) and Asian (9.2% vs 6.3%; p<0.001) as compared to the older age group. YPs were more likely to present with distant metastasis (27.7% vs 19.1%; p<0.001) and had more poorly differentiated tumors (20.3 % vs 18.0%; p< 0.001). YPs also received more cancer directed surgery (92.6 % vs 91%; p<0.001) compared to their older counterparts. Five year survival was better for younger patients in all stages{table 1}. After controlling for gender, race, marital status, grade, stage, cancer specific surgery and post-operative radiation, we found that age is an independent predictor of death, and younger patients with colon cancer had a lower risk of dying (HR 0.767; p<0.001). Conclusions: Previous studies of YPs with colon cancer were found to have either equivalent or better survival in stages II and IV compared to older patients. Our study shows that young patients less than 50 years of age have more advanced stages of colon cancer at diagnosis but have better stage specific survival in all stages.
Stage of colon cancer | Young (< 50 yrs) N=29,276 |
Older (≥ 50 years) N=346,167 |
P-value |
---|---|---|---|
Localized | 95.6% | 91.1% | <0.001 |
Regional | 76.7% | 72.8% | <0.001 |
Distant | 20.3% | 16.8% | <0.001 |
Unstaged | 69.3% | 50.4% | <0.001 |
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