Int J Colorectal Dis (2012) 27:249–255 DOI 10.1007/s00384-011-1299-0
ORIGINAL ARTICLE
Colorectal carcinoma in different age groups A histopathological analysis Leonardo Maciel da Fonseca & Magda Maria Profeta da Luz & Antônio Lacerda-Filho & Mônica Maria Demas Alvares Cabral & Rodrigo Gomes da Silva
Accepted: 3 August 2011 / Published online: 16 August 2011 # Springer-Verlag 2011
Abstract Purpose Although colorectal cancer is typical in the older population, tumor onset before age 40 is not infrequent. However, the behavior, characteristics, and prognosis of this disease in young patients are unclear when compared to the older population. It is believed that young patients have a poor prognosis. We hypothesized that young patients have a poor prognosis because they have advanced-stage cancer with more aggressive pathologic features. Methods Using a university hospital database, we analyzed the histopathological features of three groups of patients with a diagnosis of colorectal cancer: young age group (patients 40 years and younger), intermediate age group (patients 41–80 years old), and old age group (patients 81 years and older). Results A total of 653 cases of colorectal cancer were analyzed. The young age group comprised 48 patients (7.4%), the intermediate age group comprised 538 patients L. M. da Fonseca (*) : M. M. P. da Luz : A. Lacerda-Filho : R. G. da Silva Division of Colorectal Surgery, Alfa Institute of Gastroenterology–Hospital das Clínicas, School of Medicine, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 110. 2º andar, CEP 30130-100 Belo Horizonte, MG, Brazil e-mail:
[email protected] M. M. D. A. Cabral Laboratory of Surgical Pathology, Alfa Institute of Gastroenterology–Hospital das Clínicas, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil M. M. D. A. Cabral Department of Pathology and Forensic Medicine of School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
(82.4%) and the old age group consisted of 67 patients (10.3%).The gender distribution was similar between the groups. The mean age of the young, intermediate, and old age groups were 34.5 (±5.0), 61.7 (±11.1) and 85.1 (±4.6) years old, respectively. The pathological features analyzed such as lymph node involvement, tumor histological classification and grade, venous, neural and lymphatic invasion, T and N classification of the TNM System, and Astler–Coller classification were similar between the age groups. Conclusions The colorectal histopathological features in young patients are similar to older patients. More aggressive characteristics or more advanced stage are not seen in younger patients. Keywords Colorectal cancer . Young . Age . Histopathological features . Prognostic factors
Introduction Colorectal cancer (CRC) is a a major burden worldwide. Age is a major risk factor for sporadic CRC. It is predominantly a disease of older individuals, and diagnosis is rare before age 40. The incidence rate begins to increase significantly between the ages of 40 and 50, and agespecific incidence rates increase with each succeeding decade thereafter [1]. In western societies, 90% of diagnosed cases occur after age 50 [2]. However, CRC can occur at any age, and the incidence of this tumor in patients younger than age 40 has increased in recent decades [3]. The behavior, characteristics, and prognosis of CRC before the age of 40 years are unclear. There is controversy about how CRC differs between younger and older patients.
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Some studies have previously reported poor pathological features for young patients with CRC in comparison to the older population [4–10]. These young patients have been portrayed as having a more aggressive disease (i.e., more advanced stage and grade). However, others have suggested no difference when stage and pathological features are compared to the older population [10–15]. Thus, the true presentation of CRC in young people remains under debate. We hypothesized that young patients would have advanced stage and more aggressive pathologic features to explain the poor prognosis observed in this group of patients. The present study aims to analyze the pathological features of CRC tumors in a series of patients in three different age groups.
Int J Colorectal Dis (2012) 27:249–255
analyzed. Because it is an exclusive study of surgical specimens, the only characteristics evaluated with the TNM system were the tumor penetration in the colorectal wall (T) and lymph node involvement (N). The TNM system was classified according to the Union for International Cancer Control (UICC) classification [18]. The lesions were also staged according to the Astler– Coller modification of Dukes classification [19]. Results were analyzed using SPSS® software for Windows® version 17.0 (SPSS, Chicago, IL). Continuous data were expressed as median and standard deviation (SD) and compared with the Kruskall–Wallis test between groups. Categorical data were compared using the χ2 test. All p values were two sided, and p
