title: Clinico-pathological patterns and survival outcome of colorectal cancer in young patients: western Saudi Arabia experience.
abstract: BACKGROUND
  The prognosis of young colorectal cancer (CRC) patients has been addressed by several studies but with contradictory results. The aim of the present study was to evaluate the clinico-pathological features of young Saudi patients with CRC in addition to displaying their survival outcome.
  
  
  METHODS
  In this retrospective study, young CRC patients (≤ 40 years) diagnosed between 2007 and 2011 from 4 centres in western Saudi Arabia, were included. Clinico-pathological features, tumor markers, dates of disease relapse and death were collected. Survival parameters were compared with those of older Saudi patients, reported in previous studies.
  
  
  RESULTS
  One hundred and sixteen young patients with CRC were identified (32.2% rectal, 67.8% colon). Some 44% were metastatic while 32.7% had stage III at diagnosis. Patients with grade 3 tumors made up 29.4% of the total while 49.5% had positive lymphovascular invasion (LVI), 56% had a lymph node (LN) ratio ≥ 0.2 and 40.2% were K-ras mutant. Median disease-free survival (DFS) and overall survival (OS) in non-metastatic cases were 22.8 and 49.6 months respectively with better median DFS in K-ras wild compared to mutant patients (28.5 vs 20.9 months, p=0.005). In metastatic cases, median OS was 19.5 months. These survival outcomes are inferior compared to those of older Saudi patients reported in prior studies.
  
  
  CONCLUSIONS
  Young CRC patients present more commonly with advanced stage and a high incidence of adverse prognostic factors such as LVI and high LN ratio. Young CRC patients seem to have worse survival compared to older Saudi patients.
authors.affiliation: Department of Medical Oncology, Oncology centre, King Abdullah Medical City, Maddinah, Saudi Arabia E-mail : samanyshereef@yahoo.com.
authors.forename: Shereef Ahmed
authors.initials: SA
authors.lastname: Elsamany
authors.forename: Abdullah Saeed
authors.initials: AS
authors.lastname: Alzahrani
authors.forename: Mervat Mahrous
authors.initials: MM
authors.lastname: Mohamed
authors.forename: Soha Ali
authors.initials: SA
authors.lastname: Elmorsy
authors.forename: Jamal Eddin
authors.initials: JE
authors.lastname: Zekri
authors.forename: Ahmed Saleh
authors.initials: AS
authors.lastname: Al-Shehri
authors.forename: Rasha Mostafa
authors.initials: RM
authors.lastname: Haggag
authors.forename: Ahmed Abdel-Reheem
authors.initials: AA
authors.lastname: Alnagar
authors.forename: Hani Abdalla
authors.initials: HA
authors.lastname: El Taani
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000378:metabolism; D015179:Colorectal Neoplasms / Q000378:metabolism / Q000401:mortality* / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012529:Saudi Arabia
chemical_list: D014408:Biomarkers, Tumor