title: Colorectal cancer in young patients: is it a distinct clinical entity?
abstract: BACKGROUND
  The incidence of colorectal cancer in young patients is increasing. It remains unclear if the disease has unique features in this age group.
  
  
  METHODS
  This was a single-center, retrospective cohort study which included patients diagnosed with colorectal cancer at age ≤40 years in 1997-2013 matched 1:2 by year of diagnosis with consecutive colorectal cancer patients diagnosed at age >50 years during the same period. Patients aged 41-50 years were not included in the study, to accentuate potential age-related differences. Clinicopathological characteristics, treatment, and outcome were compared between groups.
  
  
  RESULTS
  The cohort included 330 patients, followed for a median time of 65.9 months (range 4.7-211). Several significant differences were noted. The younger group had a different ethnic composition. They had higher rates of family history of colorectal cancer (p = 0.003), hereditary colorectal cancer syndromes (p < 0.0001), and inflammatory bowel disease (p = 0.007), and a lower rate of polyps (p < 0.0001). They were more likely to present with stage III or IV disease (p = 0.001), angiolymphatic invasion, signet cell ring adenocarcinoma, and rectal tumors (p = 0.02). Younger patients more frequently received treatment. Young patients had a worse estimated 5-year disease-free survival rate (57.6  vs. 70 %, p = 0.039), but this did not retain significance when analyzed by stage (p = 0.092). Estimated 5-year overall survival rates were 59.1 and 62.1 % in the younger and the control group, respectively (p = 0.565).
  
  
  CONCLUSIONS
  Colorectal cancer among young patients may constitute a distinct clinical entity. Further research is needed to validate our findings and define the optimal approach in this population.
authors.affiliation: Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 49100, Israel.
authors.forename: Hadar
authors.initials: H
authors.lastname: Goldvaser
authors.affiliation: Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 49100, Israel.|Sackler Faculty of Medicine, Tel Aviv University, P.O Box 39040, Tel Aviv, Israel.
authors.forename: Ofer
authors.initials: O
authors.lastname: Purim
authors.affiliation: Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 49100, Israel.|Sackler Faculty of Medicine, Tel Aviv University, P.O Box 39040, Tel Aviv, Israel.
authors.forename: Yulia
authors.initials: Y
authors.lastname: Kundel
authors.affiliation: Department of Medicine A, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, P.O Box 39040, Tel Aviv, Israel.
authors.forename: Daniel
authors.initials: D
authors.lastname: Shepshelovich
authors.affiliation: Statistical Consulting Unit, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, Israel.
authors.forename: Tzippy
authors.initials: T
authors.lastname: Shochat
authors.affiliation: Maccabi Health Services, 33 Peres St., Rishon Lezion, Israel.
authors.forename: Lital
authors.initials: L
authors.lastname: Shemesh-Bar
authors.affiliation: Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 49100, Israel.|Sackler Faculty of Medicine, Tel Aviv University, P.O Box 39040, Tel Aviv, Israel.
authors.forename: Aaron
authors.initials: A
authors.lastname: Sulkes
authors.affiliation: Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 49100, Israel. brennerb@clalit.org.il.|Sackler Faculty of Medicine, Tel Aviv University, P.O Box 39040, Tel Aviv, Israel. brennerb@clalit.org.il.
authors.forename: Baruch
authors.initials: B
authors.lastname: Brenner
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000453:epidemiology*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018279:Carcinoma, Signet Ring Cell / Q000473:pathology*; D003111:Colonic Polyps / Q000453:epidemiology*; D015179:Colorectal Neoplasms / Q000208:ethnology* / Q000235:genetics / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000453:epidemiology / Q000473:pathology; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
keywords: Age; Carcinoma; Colon; Rectum; Young
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