title: Colorectal carcinoma in pediatric patients: A comparison with adult tumors, treatment and outcomes from the National Cancer Database.
abstract: BACKGROUND
  Pediatric colorectal cancer (CRC) is rare. Comparison with adult CRC tumors, management, and outcomes may identify opportunities for improvement in pediatric CRC care.
  
  
  METHODS
  CRC patients in the National Cancer Data Base from 1998 to 2011, were grouped into Pediatric (≤21years), early onset adult (22-50) and older adult (>50) patients. Groups were compared with χ(2) and survival analysis.
  
  
  RESULTS
  A total of 918 pediatric (Ped), 157,779 early onset adult (EA), and 1,304,085 older adults (OA) were identified (p<0.01 for all comparisons). Patients ≤50 presented more frequently with stage 3 and 4 disease (Ped: 62.0%, EA: 49.7%, OA: 37.3%) and rectal cancer (Ped: 23.6%, EA: 27.5%, OA: 19.2%). Pediatric histology was more likely signet ring, mucinous, and poorly differentiated. Initial treatment was usually surgery, but patients ≤50 were more likely to have radiation (Ped: 15.1%, EA: 18.6%, and OA: 9.2%) and chemotherapy (Ped: 42.0%, EA: 38.2%, and OA: 22.7%). Children and older adults showed poorer overall survival at 5years when compared to early onset adults. Adjusting for covariates, age ≤21 was a significant predictor of mortality for colon and rectal cancers (colon HR: 1.22, rectal HR: 1.69).
  
  
  CONCLUSIONS
  This is the largest cohort of pediatric CRC patients, revealing more aggressive tumor histology and behavior in children, particularly in rectal cancer. Despite standard oncologic treatment, age ≤21 was a significant predictor of mortality. This is likely owing to worse tumor biology rather than treatment disparities and may signal the need for different therapeutic strategies.
authors.affiliation: Department of Surgery, Maine Medical Center, Portland, ME.
authors.forename: Gabriela C
authors.initials: GC
authors.lastname: Poles
authors.affiliation: Department of Surgery, Maine Medical Center, Portland, ME.
authors.forename: David E
authors.initials: DE
authors.lastname: Clark
authors.affiliation: Department of Surgery, Maine Medical Center, Portland, ME.
authors.forename: Sara W
authors.initials: SW
authors.lastname: Mayo
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham, AL.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Beierle
authors.affiliation: Department of Surgery, John Wayne Cancer Institute, Providence St. John's Medical Center, Santa Monica, CA.
authors.forename: Melanie
authors.initials: M
authors.lastname: Goldfarb
authors.affiliation: Division of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Gow
authors.affiliation: Division of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA.
authors.forename: Adam
authors.initials: A
authors.lastname: Goldin
authors.affiliation: Department of Surgery/Pediatric Surgery Division, University of Texas Health Science Center, San Rosa Children's Hospital, San Antonio, TX.
authors.forename: John J
authors.initials: JJ
authors.lastname: Doski
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Jed G
authors.initials: JG
authors.lastname: Nuchtern
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Sanjeev A
authors.initials: SA
authors.lastname: Vasudevan
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, Tufts University School of Medicine, Maine Medical Center, Portland, ME. Electronic address: Langem1@mmc.org.
authors.forename: Monica
authors.initials: M
authors.lastname: Langer
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018279:Carcinoma, Signet Ring Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D016009:Chi-Square Distribution; D002648:Child; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Colon cancer; NCDB; Outcomes; Pediatric; Rectal cancer