SURVIVAL FACTORS IN 186 PATIENTS YOUNGER THAN 40 YEARS OLD WITH COLORECTAL ADENOCARCINOMA

BACKGROUND: We sought to determine the clinical factors and tumor char acteristics associated with the reported poor prognosis in young patie nts with carcinoma of the colon and rectum. STUDY DESIGN: A retrospect ive review was performed of 186 patients younger than 40 years of age who were treated for primary colorectal adenocarcinoma. The median age was 34.3 years, and the median follow-up period was 9.4 years. Clinic al and tumor histopathologic parameters were analyzed. RESULTS: Region al lymph node metastases, distant metastases, or both, were seen at fi rst examination in 65.6 percent of young patients. Histopathologic ind icators of more aggressive tumor biology were present at a significant ly higher frequency in young patients compared with patients older tha n 40 years (p<0.001). Poorly differentiated tumor grade was present in 41.0 percent, signet-ring cell tumors were found in 11.1 percent, and infiltrating tumor leading edges were present in 69.0 percent of youn g patients. Among young patients with stage II disease, vascular invas ion was a significant negative prognostic variable (p<0.05). CONCLUSIO NS: We have demonstrated an increased incidence of three biological in dicators of aggressive and potentially metastatic tumor biology in 186 young patients with carcinoma of the colon and rectum: signet-ring ce ll carcinoma, infiltrating tumor edges, and aggressive histologic grad e in the primary adenocarcinoma. The increased incidence of these thre e histologic measures of more aggressive carcinoma of the colon and re ctum in part accounts for the higher rate of advanced disease at prese ntation in patients younger than 40.