Colorectal cancer patients aged 10-25 years have significantly worse survival rates than those of older patients, findings from a retrospective review suggest.
Overall survival (OS) at 3 years was 42% among patients aged 10-25 years and 90% among patients older than 25 years of age (P less than .0001). Recurrence-free survival (RFS) rates were 32% and 78%, respectively (P less than .0001).
Andrea A. Hayes-Jordan, MD, of the University of North Carolina at Chapel Hill, and colleagues reported these findings in the Journal of the American College of Surgeons.
The researchers reviewed patients treated at MD Anderson Cancer Center in Houston between 1991 and 2017 who were part of a prospectively maintained database. The cohort comprised 94 patients ages 10-25 years and 765 patients who were older than 25 years of age.
RFS and OS data were available for all of the older patients. For the younger group, RFS data were available for 77 patients, and OS data were available for 80 patients.
Five-year OS rates by disease stage in the younger and older groups, respectively, were:
100% and 96% for stage 1.
64% and 90% for stage 2 (P less than .0001).
58% and 85% for stage 3 (P less than .0001).
16% and 55% for stage 4 (P less than .0001).
Five-year RFS rates by disease stage in the younger and older groups, respectively, were:
100% and 95% for stage 1.
55% and 85% for stage 2 (P = .0002).
31% and 73% for stage 3 (P less than .0001).
5% and 27% for stage 4 (P less than .0001).
On multivariate analysis, patients aged 10-25 years had a significantly higher risk of recurrence or death (hazard ratio, 2.312; P less than .0001) and a higher risk of death (HR, 3.592; P less than .0001) compared with older patients.
Of note, peritoneal metastasis occurred significantly more often in the younger group (P = .00001), but predisposing conditions such as polyposis or congenital colon disease did not account for this difference.
“Besides age, mucinous and signet ring histology, poorly differentiated histology, [and] microsatellite instability were statistically significantly more prevalent in this [young] population,” the researchers wrote. “Although other authors have noted similar differences, none have identified peritoneal metastasis to be statistically significantly more prevalent in patients under 25 years.”
The reason for this finding “most certainly lies in the biology in this age group and propensity to develop peritoneal metastasis based on a yet unknown genetic factor,” the researchers added. They reported having no disclosures.
SOURCE: Hayes-Jordan A et al. J Am Coll Surg. 2020 Feb 21. doi: 10.1016/j.jamcollsurg.2019.12.043.