Colorectal cancer under 20\xa0years old: a retrospective analysis from three tertiary hospitals

Chengjing Zhou,Weiwei Xiao,Haiyang Chen,Qiaoxuan Wang,Zhizhong Pan,Xiangbo Wan,Hui Chang,Shaoqing Niu,Yong Bao,Xiaohao Wang,Xiaojun Wu,Yuanhong Gao,Peirong Ding

doi:10.1007/s00432-020-03397-2

Abstract

PurposeColorectal cancer (CRC) rarely occurs in children and adolescents. This study aimed to perform a retrospective analysis and disclose more detailed information about CRC in patients under 20 years old.MethodsMedical records of CRCs in patients under 20 years old referred to three tertiary hospitals in China from September 2000 to July 2019 were retrospectively reviewed. Clinicopathological characteristics, treatment processes and laboratory findings were summarized and treatment outcomes and prognostic factors were analyzed.ResultsA total of 33,394 CRC medical records were analyzed, and we identified seventy (0.21%) CRCs in patients under 20. The most common primary tumor location was the left hemicolon (35.7%). The prominent pathological types were mucinous adenocarcinoma (22.9%) and signet ring cell carcinoma (22.9%). Nearly half (47.1%) of the patients presented with distant metastasis at diagnosis. The fractions of patients with deficient mismatch repair (dMMR) protein expression and microsatellite instability-high (MSI-H) were 23.8% (5/21) and 71.4% (5/7), respectively. Forty-four patients underwent radical surgery. Fifty-five patients received chemotherapy and six patients received radiotherapy. One dMMR/MSI-H rectal cancer patient received immunotherapy and achieved a clinically complete response. The median overall survival (OS) time was 80 months. The 3-year and 5-year OS rates were 61.8% and 57.2%, respectively. An absence of distant metastasis was a favorable factor for OS. For stage II/III CRCs, classic adenocarcinoma and radical surgery were favorable factors for OS. For stage IV CRCs, primary location at the colon was a favorable factor for OS.ConclusionChild and adolescent CRC patients are likely to have distant metastasis, undifferentiated, left hemicolon location, and a dMMR/MSI-H phenotype at diagnosis. Additional efforts are needed to improve their survival outcomes.

Highlights

Colorectal cancer (CRC) is the third most common cancer in incidence and ranks second in terms of cancer-related mortality (Bray et al 2018)
AYA CRCs present with more advanced stage, poorer cell differentiation, and higher prevalence of signet ring cell histology, and the primary tumors are commonly located in the left side of the colon at diagnosis
A total of 33,394 CRC medical records were analyzed, and we identified 70 CRCs (0.21%) in patients who were under 20 years old with histological diagnoses of adenocarcinoma, some of whom were referred from other hospitals

Summary

Introduction

Colorectal cancer (CRC) is the third most common cancer in incidence and ranks second in terms of cancer-related mortality (Bray et al 2018). Adolescent and young adult (AYA) cancers accounted for 5% of all newly diagnosed invasive cancers in the United States between 2011 and 2015 (Close et al 2019). CRC accounted for only 2.5–3.5% of cancer incidence in adolescents from 15 to 19 years old from 2011 to 2015, the 5-year survival rate was lower than in many other cancers (Close et al 2019). Both the incidence and mortality rates of CRC are increasing in China in recent decades (Arnold et al 2017). To better characterize the clinical features, treatment strategies, and outcomes of CRC in children and adolescents, we performed an analysis of CRCs from three tertiary hospitals in South China

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