Abstract
e15590 Background: The incidence of colorectal cancer in young adults ( < 44 years) is on the rise. Identifying young patients at risk of regional lymph node metastasis (LNM) is crucial for long-term survival. Prior studies have examined rates of LMN in average risk patients. The objective of this study is to fill the knowledge gap by examining predictors of LMN in young patients using a national cancer registry. Methods: Patients diagnosed with T1 colorectal cancer were identified in the Surveillance, Epidemiology, and End Results register 2000-2017. Potential predictors of LNM and its impact on cancer-specific survival were assessed in logistic and Cox regression with and without multivariable adjustment. Results: In total, 692 patients with T1 colorectal cancer were identified. Most tumors occurred in White race (77.7%), between 40-44 years of age (49.4%), grade III tumor differentiation (59.8%), 1 to 1.9 cm in size (32.2%), and were left sided tumors (61.1%). The overall LNM rate was 22.5 % (n = 149). Using multivariate analysis, LMN was associated with tumor grade IV (undifferentiated) (odds ratio (OR) 2.94, CL: 1.06-8.12; p = 0.038), and increasing tumor size (1 cm – 1.9 cm: OR 2.92, CL: 1.71-4.97, p < 0.001; 2.0 cm – 2.9 cm: OR 2.00, CI: 1.05-3.77, p = 0.034; and ≥ 3.0 cm: OR 2.68, CI: 1.43-5.01, p = 0.002). Five-year cancer-specific survival for patients with LNM was 91% and for patients without LNM 98%. Adjusted cox proportion models showed that LMN was associated with four times higher rate of mortality (hazard ratio (HR) 4.43, CI: 1.27-15.52, p = 0.020). Conclusions: In conclusion, the overall LNM rate is approximately 22% for T1 CRC in young patients (less than 45 years). Tumor size and tumor grade are significant predictors for LNM in patients with T1 CRC cancer. Moreover, positive lymph node involvement is a significant prognostic factor for cancer specific survival. Thus, careful preoperative assessment of lymph node status is essential in clinical decision making, to achieve better long-term outcomes
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