Comparing Clinical Characteristics and Outcomes of Young-onset and Late-onset Colorectal Cancer: An International Collaborative Study

Young Soo Rho; Marine Gilabert; Karol Polom; Archil Aladashvili; Katerina Kopeckova; Vera Megdanova; Niamh Coleman; Megan Greally; Daniele Marrelli; Franco Roviello; Ray McDermott; Veneta Petrova; Zhasmina Mihaylova; Zbynek Bortlicek; Jana Prausova; Gerald Batist; Laurent Azoulay; Petr Kavan

doi:10.1016/j.clcc.2017.03.008

Comparing Clinical Characteristics and Outcomes of Young-onset and Late-onset Colorectal Cancer: An International Collaborative Study

Clin Colorectal Cancer. 2017 Dec;16(4):334-342. doi: 10.1016/j.clcc.2017.03.008. Epub 2017 Mar 21.

Authors

Young Soo Rho¹, Marine Gilabert², Karol Polom³, Archil Aladashvili⁴, Katerina Kopeckova⁵, Vera Megdanova⁶, Niamh Coleman⁷, Megan Greally⁷, Daniele Marrelli³, Franco Roviello³, Ray McDermott⁶, Veneta Petrova⁶, Zhasmina Mihaylova⁶, Zbynek Bortlicek⁸, Jana Prausova⁵, Gerald Batist⁹, Laurent Azoulay¹⁰, Petr Kavan¹¹

Affiliations

¹ Gerald Bronfman Department of Oncology, McGill University Faculty of Medicine, Montreal, QC, Canada.
² Department of Medical Oncology, Paoli-Calmettes Institute, Marseille, France.
³ General and Oncological Surgery Department, University of Siena, Siena, Italy.
⁴ GI Cancer Research Unit and Oncology Surgery, National Cancer Center, Tbilisi, Georgia.
⁵ Department of Oncology, Second Faculty of Medicine-Charles University Prague and Motol University Hospital, Prague, Czech Republic.
⁶ Department of Medical Oncology, Military Medical Academy, Sofia, Bulgaria.
⁷ Department of Medical Oncology, St. Vincent's University Hospital, Dublin, Ireland.
⁸ Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
⁹ Gerald Bronfman Department of Oncology, McGill University Faculty of Medicine, Montreal, QC, Canada; Lady Davis Institute and Segal Cancer Centre, Jewish General Hospital-McGill University, Montreal, QC, Canada.
¹⁰ Gerald Bronfman Department of Oncology, McGill University Faculty of Medicine, Montreal, QC, Canada; Lady Davis Institute and Segal Cancer Centre, Jewish General Hospital-McGill University, Montreal, QC, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
¹¹ Gerald Bronfman Department of Oncology, McGill University Faculty of Medicine, Montreal, QC, Canada; Lady Davis Institute and Segal Cancer Centre, Jewish General Hospital-McGill University, Montreal, QC, Canada. Electronic address: petr.kavan@mcgill.ca.

PMID: 28462853
DOI: 10.1016/j.clcc.2017.03.008

Abstract

Background: Compared with the general population, the incidence of young-onset (YO) colorectal cancer (CRC) is increasing. However, a significant knowledge gap exists in the clinical characteristics, treatment patterns, and outcomes for these patients.

Materials and methods: Six international tertiary cancer centers conducted a retrospective study. Patients with YO CRC (aged 18-44 years) and LO CRC (aged > 44 years) diagnosed with histologically proven colorectal adenocarcinoma from June 2003 to June 2014 were enrolled. Patients were randomly chosen from each center's database, and the patient demographics and treatment information were collected. The data were then centralized, and the final analysis was performed at a single institution. Cox proportional hazards models were used to estimate the crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for progression-free survival and mortality, and YO was compared with LO. Site-specific HRs were pooled using a random-effects meta-analysis.

Results: Overall, 498 patients, including 224 with YO (129 men; mean age, 37 ± 5.5 years) and 274 with LO (167 men; mean age, 64.8 ± 9.5 years) CRC, were included. At the diagnosis, 137 patients (61.2%) and 122 patients (44.5%) with YO and LO CRC had metastatic disease, respectively. For both cohorts, the 3 most common presenting symptoms were pain, hematochezia, and weight loss. Surgery was performed in 141 YO (63.0%) and 219 LO (79.9%) patients. The longitudinal noncurative treatment patterns were similar, but more biologic therapy was used for these YO patients. The pooled progression-free survival analysis results for first-line noncurative treatment favored LO (HR, 1.96; 95% CI, 1.04-3.68). The mortality analysis showed no significant differences between the 2 groups (YO: HR, 1.53; 95% CI, 0.91-2.58).

Conclusion: Despite similar treatment patterns and survival outcomes, YO disease might be clinically more aggressive.

Keywords: Adolescent and young adults; Metastatic colorectal cancer; Real world; Treatment pattern; Young-onset CRC.

Publication types

Multicenter Study

MeSH terms

Adenocarcinoma / epidemiology
Adenocarcinoma / pathology*
Adenocarcinoma / therapy
Adult
Age of Onset
Aged
Aged, 80 and over
Biological Therapy / methods*
Colorectal Neoplasms / epidemiology
Colorectal Neoplasms / pathology*
Colorectal Neoplasms / therapy
Disease-Free Survival
Female
Humans
Incidence
International Cooperation
Male
Middle Aged
Neoplasm Metastasis
Proportional Hazards Models
Retrospective Studies
Treatment Outcome
Young Adult