Abstract
BackgroundOld age at diagnosis is associated with poor survival in colorectal cancer (CRC) for unknown reasons. Recent data show that colonoscopy is efficient in preventing left-sided cancers only. We examine the association of Tumor Node Metastasis (TNM) classes with diagnostic age and patient characteristics.MethodsThe Swedish Family-Cancer Database has data on TNM classes on 6,105 CRC adenocarcinoma patients. Ordinal logistic regression analysis was performed to model tumor characteristics according to age at diagnosis, tumor localization, gender, socioeconomic status, medical region and family history. The results were compared to results from survival analysis.ResultsThe only parameters systematically associated with TNM classes were age and tumor localization. Young age at diagnosis was a risk factor for aggressive CRC, according to stage, N and M with odds ratios (ORs) ranging from 1.80 to 1.93 for diagnosis before age 50 years compared to diagnosis at 80+ years. All tumor characteristics, particularly T, were worse for colon compared to rectal tumors. Right-sided tumors showed worse characteristics for all classifiers but M. The survival analysis on patients diagnosed since 2000 showed a hazard ratio of 0.55 for diagnosis before age 50 years compared to diagnosis at over 80 years and a modestly better prognosis for left-sided compared to right-sided tumors.ConclusionsThe results showed systematically more aggressive tumors in young compared to old patients. The poorer survival of old patients in colon cancer was not related to the available tumor characteristics. However, these partially agreed with the limited colonoscopic success with right-sided tumors.
Highlights
Old age at diagnosis is associated with poor survival in colorectal cancer (CRC) for unknown reasons
The 5-year survival for colon adenocarcinoma reached about 60% in Sweden towards the end of the 1990s being a few percentage points better for women compared to men [4]; for rectal adenocarcinoma the male survival was about 55% compared to over 60% for women
History of colon cancer appears to be associated with better survival, which has been observed for hereditary nonpolyposis colorectal cancer (HNPCC) patients [18,19,20]
Summary
Old age at diagnosis is associated with poor survival in colorectal cancer (CRC) for unknown reasons. The reasons for the improvements in survival have been suggested to be earlier diagnosis and better health status and care [4,5]. Data on colon cancer tend to point to the opposite: younger patients present more aggressive and advanced tumors [11,14,15,16]. History of colon cancer appears to be associated with better survival, which has been observed for hereditary nonpolyposis colorectal cancer (HNPCC) patients [18,19,20]
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