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An Update on Young-Onset Colorectal Cancer, an NCDB Analysis
Elie Sutton*1, Geoffrey Bellini1, Dave Lee2, Linda Njoh1, Richard L. Whelan1
1Surgery, Mt. Sinai St. Luke's Roosevelt, NY, NY; 2Surgery, John Wayne Cancer Institute, Santa Monica, CA
Introduction: It has been well documented that colorectal cancer (CRC) rates are slowly declining overall; however, rates are rising in the pre-screening (under 50 year old) young onset (YO) population. A prior study that used National Cancer Database (NCDB) data showed a notable rise in the number of YO CRC’s from 2001-2010. The present study sought to re-evaluate these trends for all CRC’s and, in particular, in the YO population.
Methods: The NCDB Participant User File was queried for all CRC cases from 2004-2013. The proportion of YO CRC’s was determined. Other factors such as stage at presentation, evidence of distant metastases, surgical approach, length of inpatient hospital stay, readmission rates, as well as 30-day mortality were assessed. Analysis was performed to note differences between this group and the subset of patients (pts) with later-onset (LO) disease (age ≥ 50).
Results: A total 1,010,530 CRC pts were identified (colon, 70.5%; rectosigmoid, 7.6%; rectum, 21.9%). Over the 10 year period the number of CRC cases fell by 2.5% in pts aged ≥50, and rose 11.4% in pts aged <50. The annual percent change of YO CRC’s was calculated from 2004-2013; during that period a mean increase of 1.28% per year was noted (95% C.I. 0.77%-1.78%; P<0.001). The analysis also suggests an increase of 136.35 cases for every additional year (P<0.001). Compared with LO disease, YO CRCs were more prevalent among nonwhite race/ethnicity pts (22.1% vs. 16.0%; P<0.001). With regards to stage at presentation, the <50 group had lower percentages of Stage 0-2 pts and a greater percentage of Stage 3-4 pts as compared to the ≥50 group. The results for the YO and LO groups, respectively, were: stage 0, 5.2% vs. 7.2%; stage 1, 18.4% vs. 24%; stage 2, 20.3% vs. 25.5%, stage 3, 30.6% vs. 25.1%; stage 4, 25.6% vs. 18.2%. The differences between the two groups were statistically significant at each stage (P<0.001). Liver metastasis were more prevalent in the YO than in the LO group (in pts for which this data was available, 19.4% vs. 13.8%; P<0.001). Data on surgical approach was available from 2010-2013. A minimally invasive approach was attempted in 47.4% of patients <50, and in 46.6% of pts ≥ 50 (P=0.004). Significant differences were noted in length of stay ≤5 days (56.6% vs. 43.3%; P0.001), 30-day mortality (0.6% vs. 3.5%; P<0.001), 90-day mortality (1.6% vs. 6.4%; P<0.001), as well as insurance status (no insurance in 8.5% vs. 2.8%; P<0.001), between the YO and LO groups.
Conclusion: These results show that the number of young-onset CRC’s continues to increase in the US; the reason(s) is unclear. Since the stage at diagnosis is further advanced for YO pts, it is imperative that MD’s maintain a lower threshold for colonoscopy in pts with bleeding or other colorectal complaints. Screening guidelines may need to be revisited in order to identify CRC cases earlier.
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