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Better long-term survival in young patients with non-metastatic colorectal cancer after surgery, an analysis of 69,835 patients in SEER database.

Li Q, Cai G, Li D, Wang Y, Zhuo C, Cai S - PLoS ONE (2014)

Bottom Line: Kaplan-Meier methods were adopted and multivariable Cox regression models were built for the analysis of long-term survival outcomes and risk factors.Young patients showed significantly higher pathological grading (p<0.001), more cases of mucinous and signet-ring histological type (p<0.001), later AJCC stage (p<0.001), more lymph nodes (≥ 12 nodes) dissected (p<0.001) and higher metastatic lymph node ratio (p<0.001).Further analysis showed this significant difference only existed in stage II and III patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.

ABSTRACT

Objective: To compare the long-term survival of colorectal cancer (CRC) in young patients with elderly ones.

Methods: Using Surveillance, Epidemiology, and End Results (SEER) population-based data, we identified 69,835 patients with non-metastatic colorectal cancer diagnosed between January 1, 1988 and December 31, 2003 treated with surgery. Patients were divided into young (40 years and under) and elderly groups (over 40 years of age). Five-year cancer specific survival data were obtained. Kaplan-Meier methods were adopted and multivariable Cox regression models were built for the analysis of long-term survival outcomes and risk factors.

Results: Young patients showed significantly higher pathological grading (p<0.001), more cases of mucinous and signet-ring histological type (p<0.001), later AJCC stage (p<0.001), more lymph nodes (≥ 12 nodes) dissected (p<0.001) and higher metastatic lymph node ratio (p<0.001). The 5-year colorectal cancer specific survival rates were 78.6% in young group and 75.3% in elderly group, which had significant difference in both univariate and multivariate analysis (P<0.001). Further analysis showed this significant difference only existed in stage II and III patients.

Conclusions: Compared with elderly patients, young patients with colorectal cancer treated with surgery appear to have unique characteristics and a higher cancer specific survival rate although they presented with higher proportions of unfavorable biological behavior as well as advanced stage disease.

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Survival curves in CRC patients according to age status.Young group vs. Elderly group, χ2 = 35.84, P<0.001.
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pone-0093756-g001: Survival curves in CRC patients according to age status.Young group vs. Elderly group, χ2 = 35.84, P<0.001.

Mentions: The overall 5-year CCSS was 78.6% in young group and 75.3% in elderly group, which had significant difference in univariate log-rank test (P<0.001) (Fig. 1). Besides, early year of diagnosis (P<0.001), male (P<0.001), African race (P<0.001), rectal cancer (P<0.001), poor or undifferentiation tumor grade (P<0.001), mucinous or signet-ring cancer (P<0.001), higher AJCC stage(P<0.001), less number in LNs dissection(p<0.01) and higher metastatic LNR(P<0.001), were identified as significant risk factors for poor survival on univariate analysis(Table 2). When multivariate analysis with Cox regression was performed, we convinced all these factors as independent prognostic factors (Table 3). These included age (elderly, hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.32–1.52), year of diagnosis (1994–1999, HR 0.83, 95% CI 0.80–0.86; 2000–2003, HR 0.74, 95% CI 0.71–0.76), gender (female, HR 0.87, 95%CI 0.85–0.90), race(African American, HR 1.19,95%CI 1.14–1.25;others, HR 1.59,95%CI 1.50–1.69), primary site(rectal cancer, HR 1.10,95%CI 1.07–1.14), pathological grading(poor or undifferentiation tumor, HR 1.32,95%CI 1.28–1.37), histological type(mucinous cancer, HR 1.10,95%CI 1.03–1.12; signet-ring cancer, HR 1.72,95%CI 1.54–1.92), AJCC stage(stage II, HR 2.91,95%CI 2.59–3.27; stage III, HR 4.83,95%CI 3.32–7.03), metastatic LNR(rN2, HR 1.92,95%CI 1.34–2.75; rN3, HR 3.23,95%CI 2.26–4.63), while the risk between rN0 and rN1 was not statistical difference(P = 0.45).


Better long-term survival in young patients with non-metastatic colorectal cancer after surgery, an analysis of 69,835 patients in SEER database.

Li Q, Cai G, Li D, Wang Y, Zhuo C, Cai S - PLoS ONE (2014)

Survival curves in CRC patients according to age status.Young group vs. Elderly group, χ2 = 35.84, P<0.001.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3974782&req=5

pone-0093756-g001: Survival curves in CRC patients according to age status.Young group vs. Elderly group, χ2 = 35.84, P<0.001.
Mentions: The overall 5-year CCSS was 78.6% in young group and 75.3% in elderly group, which had significant difference in univariate log-rank test (P<0.001) (Fig. 1). Besides, early year of diagnosis (P<0.001), male (P<0.001), African race (P<0.001), rectal cancer (P<0.001), poor or undifferentiation tumor grade (P<0.001), mucinous or signet-ring cancer (P<0.001), higher AJCC stage(P<0.001), less number in LNs dissection(p<0.01) and higher metastatic LNR(P<0.001), were identified as significant risk factors for poor survival on univariate analysis(Table 2). When multivariate analysis with Cox regression was performed, we convinced all these factors as independent prognostic factors (Table 3). These included age (elderly, hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.32–1.52), year of diagnosis (1994–1999, HR 0.83, 95% CI 0.80–0.86; 2000–2003, HR 0.74, 95% CI 0.71–0.76), gender (female, HR 0.87, 95%CI 0.85–0.90), race(African American, HR 1.19,95%CI 1.14–1.25;others, HR 1.59,95%CI 1.50–1.69), primary site(rectal cancer, HR 1.10,95%CI 1.07–1.14), pathological grading(poor or undifferentiation tumor, HR 1.32,95%CI 1.28–1.37), histological type(mucinous cancer, HR 1.10,95%CI 1.03–1.12; signet-ring cancer, HR 1.72,95%CI 1.54–1.92), AJCC stage(stage II, HR 2.91,95%CI 2.59–3.27; stage III, HR 4.83,95%CI 3.32–7.03), metastatic LNR(rN2, HR 1.92,95%CI 1.34–2.75; rN3, HR 3.23,95%CI 2.26–4.63), while the risk between rN0 and rN1 was not statistical difference(P = 0.45).

Bottom Line: Kaplan-Meier methods were adopted and multivariable Cox regression models were built for the analysis of long-term survival outcomes and risk factors.Young patients showed significantly higher pathological grading (p<0.001), more cases of mucinous and signet-ring histological type (p<0.001), later AJCC stage (p<0.001), more lymph nodes (≥ 12 nodes) dissected (p<0.001) and higher metastatic lymph node ratio (p<0.001).Further analysis showed this significant difference only existed in stage II and III patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.

ABSTRACT

Objective: To compare the long-term survival of colorectal cancer (CRC) in young patients with elderly ones.

Methods: Using Surveillance, Epidemiology, and End Results (SEER) population-based data, we identified 69,835 patients with non-metastatic colorectal cancer diagnosed between January 1, 1988 and December 31, 2003 treated with surgery. Patients were divided into young (40 years and under) and elderly groups (over 40 years of age). Five-year cancer specific survival data were obtained. Kaplan-Meier methods were adopted and multivariable Cox regression models were built for the analysis of long-term survival outcomes and risk factors.

Results: Young patients showed significantly higher pathological grading (p<0.001), more cases of mucinous and signet-ring histological type (p<0.001), later AJCC stage (p<0.001), more lymph nodes (≥ 12 nodes) dissected (p<0.001) and higher metastatic lymph node ratio (p<0.001). The 5-year colorectal cancer specific survival rates were 78.6% in young group and 75.3% in elderly group, which had significant difference in both univariate and multivariate analysis (P<0.001). Further analysis showed this significant difference only existed in stage II and III patients.

Conclusions: Compared with elderly patients, young patients with colorectal cancer treated with surgery appear to have unique characteristics and a higher cancer specific survival rate although they presented with higher proportions of unfavorable biological behavior as well as advanced stage disease.

Show MeSH
Related in: MedlinePlus