Comparison of Stage and Lymph Node Ratio in Young and Older Patients with Colorectal Cancer Operated in a Tertiary Hospital in Nepal

Abstract

Background: Colorectal cancer is being diagnosed more frequently in the young and it presents in an advanced stage. In TNM staging, stage depends on tumor size and number of positive nodes, which depend on location of tumor as well as the extent of dissection.The lymph node ratio is regarded as a more reliable marker for prognosis. In this study, we compare epidemiology of colorectal cancer in the young (<40 years) and older patients as well as the LNR. Methods:Patients with colorectal cancer operated at the Tribhuvan University Teaching Hospital, Kathmandu, Nepal for a period of 4 years (2012 -2016) were included in the study. Patients were grouped into young (≤ 40 years) and older (> 40 years) and clinic-pathological data such as site of lesion, clinical stage, and lymph node ratio were compared. Results:Of the 95 patients of colorectal cancer, 25 patients were of age ≤ 40 years (26%) and they had a higher median stage at diagnosis. In patients above 40 years, it was diagnosed at a relatively earlier stage. The mean number of positive nodes was 11.64 in younger patients whereas it was 18.34in those more than 40 years of age,but younger patients had higher lymph node ratio than elderly (0.31 vs 0.13) (P-value ≤ 0.005). Conclusions:Young patients with colorectal cancer tend to have more advanced disease. The lymph node metastasis and lymph node ratio tend to be higher in young patients.

Incidence, risk factors, and a predictive model for lymph node metastasis of submucosal (T1) colon cancer: A population‐based study

“…Surprisingly, elder age was an important protective predictor of LNM, as the risk of LNM declined continuously from younger patients, and reached the lowest risk in octogenarians. A study have reported that, compared with elder patients with CRC, young patients with CRC were prone to have a higher risk of LNM, which was in agreement with our finding. Based on our nomogram, for example, when a patient aged >75 years, the point on the axis was <30.…”

Construction of a diagnostic nomogram model for predicting the risk of lymph node metastasis in clinical T1 or T2 colon cancer based on the SEER database

“…The risk of metastasis reached its lowest level above 65 years of age. This was consistent with a previous finding that younger patients with colorectal cancer tended to have a higher risk of LNM than older patients ( 20 ). It seems the old age plays a protective role for LNM in patients with T1 or T2 colon cancer ( 21 ).…”

Risk Factors for Predicting Lymph Node Metastasis in Submucosal Colorectal Cancer

“…A study reported that younger patients with CRC were prone to have a higher risk of LNM compared with older patients [28]. Any surgery always involves risks, such as infection, bleeding, and AL, and especially they are severe problems in older populations.…”