Young patients with colorectal cancer have poor survival in the first twenty months after operation and predictable surv
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RESEARCH
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
Young patients with colorectal cancer have poor survival in the first twenty months after operation and predictable survival in the medium and longterm: Analysis of survival and prognostic markers KK Chan1,3, B Dassanayake3, R Deen2,3, RE Wickramarachchi3, SK Kumarage3, S Samita4, KI Deen5*
Abstract Objectives: This study compares clinico-pathological features in young (50 years) with colorectal cancer, survival in the young and the influence of pre-operative clinical and histological factors on survival. Materials and methods: A twelve year prospective database of colorectal cancer was analysed. Fifty-three young patients were compared with forty seven consecutive older patients over fifty years old. An analysis of survival was undertaken in young patients using Kaplan Meier graphs, non parametric methods, Cox’s Proportional Hazard Ratios and Weibull Hazard models. Results: Young patients comprised 13.4 percent of 397 with colorectal cancer. Duration of symptoms and presentation in the young was similar to older patients (median, range; young patients; 6 months, 2 weeks to 2 years, older patients; 4 months, 4 weeks to 3 years, p > 0.05). In both groups, the majority presented without bowel obstruction (young - 81%, older - 94%). Cancer proximal to the splenic flexure was present more in young than in older patients. Synchronous cancers were found exclusively in the young. Mucinous tumours were seen in 16% of young and 4% of older patients (p < 0.05). Ninety four percent of young cancer deaths were within 20 months of operation. At median follow up of 50 months in the young, overall survival was 70% and disease free survival 66%. American Joint Committee on Cancer (AJCC) stage 4 and use of pre-operative chemoradiation in rectal cancer was associated with poor survival in the young. Conclusion: If patients, who are less than 40 years old with colorectal cancer, survive twenty months after operation, the prognosis improves and their survival becomes predictable.
Introduction Colorectal cancer is the commonest malignancy in the gastrointestinal tract and the fourth leading cause of cancer associated death in the world. In the United States, it has been estimated that 108,070 new cases of colon cancer and 40,740 rectal cancers, respectively, would have been diagnosed in 2008 and 49,960 would have died from colorectal cancer [1]. Compared with the West, colorectal cancer in South and South East Asia has been reported to occur with a greater * Correspondence: [email protected] 5 Department of Surgery University of Kelaniya Medical School, Sri Lanka Full list of author information is available at the end of the article
frequency in young patients (usually 0.05). The longest duration for a particular symptom was considered in determining duration of symptoms. In the young, the most common presenting symptom was alteration in bowel habit (47; 89%). Other symptoms were rectal bleeding (68%), non-specific abdominal pain (38%), tenesmus (24.5%), anaemia (6%) an
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