Do Survival Gains Match More Intense Treatment in Younger Patients With Colon Cancer?


Key Points

  • Younger patients were significantly more likely to receive postoperative systemic chemotherapy.
  • Modest improvements in survival were observed in younger vs older patients.

In a study reported in JAMA Surgery, Kneuertz et al found that the more frequent stage-specific use of adjuvant chemotherapy in younger patients with colon cancer did not appear to produce commensurate benefit in survival compared with outcomes in older patients.

Study Details

The study was a nationwide cohort study among U.S. hospitals accredited by the American College of Surgeons Commission on Cancer and included data from 13,102 patients diagnosed with young-onset colon adenocarcinoma at ages 18 to 49 years and 37,007 patients diagnosed with colon adenocarcinoma at ages 65 to 75 years. Patients were treated between January 2003 and December 2005 and reported to the National Cancer Data Base. The primary endpoint was stage-specific relative survival.

Use of Systemic Chemotherapy and Survival

Younger patients were more frequently diagnosed at advanced stages (P < .001), with diagnosis at stage I in 14.7% vs 24.3%, stage II in 23.5% vs 29.8%, stage III in 36.5% vs 30.3%, and stage IV in 25.3% vs 15.7%. After adjusting for patient-related and tumor-related factors, young patients were more likely to receive systemic chemotherapy, particularly multiagent regimens, at all stages, with odds ratios of 2.88 (95% confidence interval [CI] = 2.21–3.77) for stage I, 3.93 (95% CI = 3.58–4.31) for stage II, 2.42 (95% CI = 2.18–2.68) for stage III, and 2.74 (95% CI = 2.44–3.07) for stage IV. Relative risk for death was nonsignificantly reduced in younger vs older patients with stage II disease (0.90, 95% CI = 0.69–1.17) and significantly reduced by modest  amounts in younger patients with stage III disease (0.89, 95% CI = 0.81–0.97) and stage IV disease (0.84, 95% CI = 0.79–0.90).

The investigators concluded: “Young adults with colon cancer received significantly more postoperative systemic chemotherapy at all stages, but they experienced only minimal gain in adjusted survival compared with their older counterparts who received less treatment. This mismatch suggests that attention should be given to long-term cancer survivorship in young adults with colon cancer because they likely face survivorship needs that are distinct from those of their older counterparts.”

Y. Nancy You, MD, MHSc, of The University of Texas MD Anderson Cancer Center, is the corresponding author for the JAMA Surgery article.

The study was supported by grants from The University of Texas MD Anderson Cancer Center and National Cancer Institute. The study authors reported no potential conflicts of interest.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.