Colorectal cancer characteristics and outcomes in patients less than age 50: A comparison of an urban university hospital with the NCI SEER database.

Abstract

3621 Background: Cancer of the colon and rectum is the third most commonly occurring cancer, as well as the third leading cause of cancer deaths in American men and women. Colorectal cancer in younger patients is believed to have worse pathological features and prognosis than in older patients. The objective of this study was to assess pathological features and outcomes of CRC in patients less than age 50 using an institutional sample and comparing to the Surveillance, Epidemiology and End Results (SEER) database. Methods: Included in the study were a total of 4595 cases from the Tumor Registry at Thomas Jefferson University Hospital (TJUH) over a twenty year period from 1988 through 2007 and 290,338 cases from the Surveillance, Epidemiology and End Results (SEER) database from 1988 through 2004. Patients less than age 50 were compared to those age 50 and older. Results: Patients under age 50 with CRC presented with more advanced stage tumors in both data sets (<0.0001) , and had more poorly differentiated tumors than older patients (PTJUH=0.02754; PSEER<0.0001). Patients under 50 also had more mucinous/signet ring cell tumors with 12 percent to 8.1 percent in the TJUH data (p=0.002916) and 13.2 percent to 10.3 percent in the SEER data (p<0.0001), with younger males having the highest prevalence in both data sets. Younger patients had fewer proximal tumors than patients 50 and over, and a higher proportion of rectal tumors (p<0.001). Patients under age 50 were more likely to have positive nodes at all stages (PSEER <0.0001) relative to 50 and over, as well as more likely to develop peritoneal metastases (PTJUH=0.3507),, but less likely to have lung metastases PTJUH=0.05249) than older pts. Despite their poor pathologic features, patients under age 50 had better than or equal survival to those 50 and older. Conclusions: Colorectal cancer patients under age 50 presented with worse histological characteristics and metastasized much sooner, yet the younger patients had better than or equal survival to those ages 50 and older. Ongoing studies will assess differences in treatment and molecular features between younger and older colorectal cancer patients.