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Early-onset non-metastatic colon cancers do not portend worse prognosis — implications for adjuvant chemotherapy

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Abstract

Background

Early-onset colon cancers are increasing and the independent influence of age on prognosis and therapeutic efficacy of adjuvant therapy is unclear. The primary aim of the present study was to determine if young age was an independent prognostic factor for survival. Secondarily, age would be used in the context of known factors that predict benefit with adjuvant chemotherapy in stages II and III.

Methods

Retrospective, single centre study of operated, non-metastatic colon cancer (> 15 cm from anal verge) without pre-operative therapy. Early onset cancers were defined as age ≤ 45 years. Primary endpoint was disease-free survival (DFS).

Results

Six-hundred thirty-three patients were included with 206 (32.5%) early-onset cancers. With a median follow-up of 48 months, 5-year DFS was 79.5% and 76.2% for early and late-onset cancers, respectively (p – 0.585). In multivariate analysis, only tumour sidedness, family history, T4 stage, node positivity and microsatellite instability status influenced DFS and not the age of onset (HR — 0.969; 95% — 0.63–1.49). These results were consistent with different models and with stage-wise distribution.

Conclusions

Early-onset colon cancers treated with curative intent had survivals similar to older cohorts. Age was not an independent prognostic factor for recurrences. Age did not influence disease-free survival when stage-wise predictive variables for therapeutic benefit with adjuvant chemotherapy were considered.

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Data availability

The data that support the findings of this study are available on request from the corresponding author on reasonable request. The data are not publicly available due to privacy or ethical restrictions.

Abbreviations

ASA :

American Society of Anaesthesiologist

BMI :

Body-mass Index

CEA :

Carcinoembryonic antigen

CI :

Confidence interval

CRC :

Colorectal cancer

CT :

Computerized tomography

DFS :

Disease-free survival

ECOG :

Eastern Cooperative Oncology Group

HR :

Hazard ratios

IDEA :

International duration evaluation of adjuvant chemotherapy

IQR:

inter-quartile range

MSI :

Microsatellite instability

NCCN :

National Comprehensive Cancer Network

OS :

Overall survival

SD :

Standard deviation

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Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute (HNBI), Mumbai, Maharashtra, India, 400012

    Mufaddal Kazi, Jayesh Gori, S. Srivishnu, Ashwin Desouza & Avanish Saklani

  2. Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Dr Ernest Borges Marg, Parel, Mumbai, 400012, Maharashtra, India

    Avanish Saklani

Authors
  1. Mufaddal Kazi
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  2. Jayesh Gori
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  3. S. Srivishnu
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  4. Ashwin Desouza
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Correspondence to Avanish Saklani.

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No pre-registration exists for the study reported in this article due to its retrospective nature.

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Kazi, M., Gori, J., Srivishnu, S. et al. Early-onset non-metastatic colon cancers do not portend worse prognosis — implications for adjuvant chemotherapy. Langenbecks Arch Surg 407, 2027–2034 (2022). https://doi.org/10.1007/s00423-022-02500-0

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  • DOI: https://doi.org/10.1007/s00423-022-02500-0

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