Clinical outcomes in patients age 40 or younger at diagnosis of synchronous metastatic colorectal cancer: A 20-year experience at Memorial Sloan-Kettering Cancer Center.

Abstract

e14050 Background: The incidence of rectal cancer in patients under 40 years is increasing; however, the impact of age ≤40 at diagnosis of CRC on outcome is unclear. We reviewed the records of young adults diagnosed with metastatic CRC at our institution over a 20-year period to assess the impact of demographic, pathologic and treatment related variables on clinical outcomes. Methods: Approval was obtained from the Institutional Review Board. 301 patients diagnosed with synchronous metastatic CRC age ≤ 40 years from Jan 1991 to Jan 2011 were identified from the institutional database. Overall survival (OS) was calculated from the date of cytological or pathological confirmation of diagnosis to date of death or last follow-up, and was calculated using the Kaplan-Meier method. Results: Median OS was 2 years. Factors associated with improved survival included liver limited disease, resection of hepatic metastases and use of hepatic arterial chemotherapy. Patients with a known history of Crohn's disease or ulcerative colitis and those with African American or Asian ethnicity had significantly reduced survival. KRAS mutation was identified in 19 of 55 patients (35%). Conclusions: In this retrospective analysis, mOS of young patients with metastatic CRC at diagnosis is similar to that expected in an unselected population. Patients who underwent resection of hepatic metastases had significantly better survival, reflecting the small but significant cure rate of patients rendered disease free by hepatic metastatectomy. Characteristics HR 95% CI P Male vs. female 0.977 (0.756-1.262) 0.8561 Race 0.0184 Asian vs. White 1.231 (0.727-2.086) Black vs. White 1.782 (1.187-2.675) IBD yes vs no 2.275 (1.269-4.079) 0.0058 Pregnant yes vs no 1.037 (0.604-1.782) 0.8945 Liver only disease 0.577 (0.446-0.747) <0.001 Liver resection 0.290 (0.209-0.401) <0.0001 HAI chemotherapy 0.631 (0.456-0.874) 0.0056