Age-related rates of colorectal cancer and the factors associated with overall survival

Abstract

Background: The purpose of this study was to identify differences in both demographic and pathologic factors associated with the age-related rates of colorectal cancer (CRC) and overall survival (OS). Methods: The National Cancer Data Base (NCDB), [2004][2005][2006][2007][2008][2009][2010][2011][2012][2013], was queried for patients with CRC. Patients were stratified by age (≤50 vs. ≥60 years). Multivariable analysis was performed to identify factors associated with OS.Results: A total of 670,030 patients were included; 488,121 with colon, and 181,909 with rectal or rectosigmoid cancer. For colon cancer, patients ≤50 years had higher proportions of pathologic stage III and IV disease than patients ≥60 (III: 33.7% vs. 28.6%, IV: 25.5% vs. 14.3%, respectively; P≤0.001). Similar differences were found for patients with rectal cancer (III: 35.8% vs. 28.6%, IV: 16.5% vs. 11.6%, respectively for age ≤50 and ≥60 years; P≤0.001). More aggressive pathologic factors were identified in the ≤50 cohort and were associated with worse OS, including higher tumor grade, lymphovascular invasion (LVI), perineural invasion (PNI), and elevated serum carcinoembryonic antigen (CEA). Disparities associated with OS were also identified for both colon and rectal cancer. For patients ≤50 with CRC, African-American and Hispanic race, lower income and lower education were associated with increased risk of mortality compared to the ≥60 cohort. Conclusions: There are clear differences in biological factors and in racial and socioeconomic disparities of patients with early onset CRC. Earlier screening should be seriously considered in patients under 50 years who are African-American and Hispanic, as these populations present with more aggressive and advanced disease. Changes in risk factors among younger adults over time, including diets higher in fat and increasing obesity, are also in part, contributing to this rising trend (8,9).In addition to these biologic etiologies, disparities in access to care for diagnosis and treatment of CRC among young adults has also been described. Several studies have characterized differences in the treatment of CRC, including access to surgery and chemotherapy based on age, race, geographic location and other socioeconomic factors like insurance status and income (10)(11)(12)(13)(14)(15). Importantly, differences in access to these treatments have been associated with worse survival outcomes for patients with early-onset CRC of minority racial populations (16,17). The purposes of this study were to identify differences in both demographic and pathologic factors associated with the age-related rates of CRC and to assess the interaction these variables on overall survival (OS) in early onset CRC. Methods PatientsJointly sponsored by the American Cancer Society and the American College of Surgeons, the National Cancer Data Base (NCDB) captures approximately 70% of the country's cancer cases through its participating hospitals. A query of the NCDB 2006-2012 participant user files (PUFs) was performed to identify ...

Characteristics of carcinoembryonic antigen-producing colorectal cancers: A population based study

“…In our study, African-American race was found to be an independent risk factor associated with diagnosis of colorectal cancer with elevated CEA. Supplemental data from another recent NCDB study on early onset CRC also showed that black patients were the most likely to have elevated CEA levels (32). These US population studies strongly support our findings related to elevated CEA as an important prognostic biomarker for improved disease outcome among black patients with CRC.…”

Association of age and cause-special mortality in patients with stage I/ II colon cancer: A population-based competing risk analysis

“…Most previous studies used Kaplan-Meier and Cox proportional hazards models to investigate the association between age and the prognosis of colon cancer [5][6][7][8]. Both models consider that there is a single cause to the event of interest [10].…”

“…Previous studies have reported the relationship between age and colon cancer prognosis [5][6][7][8]. However, most studies limited to the analysis of overall survival or cancer-specific mortality or used conventional Kaplan-Meier survival analysis and Cox regression models analyzed cancer-specific mortality.…”

Conventional peritoneal cytology lacks the prognostic significance of detecting local or peritoneal recurrence in colorectal cancer: An Egyptian experience

“…Increasing age is associated with fewer colon cancer‐related deaths but showed a concomitant increase in the proportion of cardiovascular disease‐related deaths 28 . Despite this, the ≤50‐year‐old cohort was supposed to be associated with worse OS due to higher proportions of pathologic stage according to Gabriel et al; 24 however, on the other hand, this age group has significantly better performance and surveillance and fewer medical comorbidities.…”

“…CRC in Egypt is commonly diagnosed in older people with a mean age of about 53 years, which is a decade younger than the corresponding age in the United States 23,24 . An increasing incidence of young adult patients diagnosed with CRC was noted, with an incidence of 29–31% 25,26 .…”