YOUNG AGE IS NOT A POOR PROGNOSTIC MARKER IN COLORECTAL-CANCER

Background There is still considerable controversy and debate regardin g the features and prognosis of colorectal cancer in young patients. M ethods One hundred and ten patients (5.1 per cent) under the age of 40 years with colorectal cancer (group Y; male:female ratio 48:62) were compared with 2064 patients with colorectal cancer aged 40 years or mo re (group O; 917 women, 1147 men). Mode of presentation, stage at diag nosis, tumour characteristics and survival were analysed. Results Pred isposing malignant conditions and family history of colorectal cancer were present in 20.9 per cent of patients in group Y versus 2.2 per ce nt in group O (P < 0.001). Common chief complaints included change in bowel habits, bleeding from the rectum and a significantly higher inci dence of abdominal pain in group Y. There was no difference in stage a t presentation between the two groups (the proportion of Dukes stage A , B, C and 'D' lesions in group Y was 8.2, 24.5, 37.3 and 30.0 per cen t respectively versus 10.5, 27.9, 33.4 and 28.1 per cent in group O). Tumour site and characteristics were similar in both groups. The incid ence of mucinous/signet ring cell and poor grade tumours was 6.9 and 1 1.8 per cent respectively in group Y and 4.5 and 10.5 per cent in grou p O. With a mean follow-up of 31.8 months, the overall 5-year survival rate was 54.8 per cent in group Y and 54.1 per cent in group O. Compa ring stage for stage, survival was not significantly different in the two groups. However, the adjusted hazard ratios of the age groups Y, M (40-59 years), S (60-79 years), and E (80 years and above) were 1.3, 1 (baseline for calculations), 1.4 and 2.4 respectively, suggesting an adverse outcome for patients in group Y compared with patients aged 4 0-59 years. Conclusion This study revealed no difference in tumour cha racteristics and survival in patients with colorectal cancer aged less than 40 years compared with those aged above 40 years. However, a hig her hazard ratio in the youngest group may connote a worse prognosis t han that for those aged 40-59 years. A significant family history of c olorectal cancer and predisposing conditions in the young warrants agg ressive screening, surveillance and treatment of the underlying condit ions. The detection of colorectal cancer in young patients should be n o different from that in the old but demands a high index of suspicion .