Colorectal adenocarcinoma in patients under 40 years of age is unusual but not rare. Some persistent controversy has remained in evaluating the prognosis of this population of colorectal cancer patients as compared with pateints over 40.
From Jan. 1982 to Dec. 1992, 187 patients with colorectal cancer who were treated by surgical resection were studied by retrospectively. They were divided into two age groups according to the age at admission, i. e. under 40 years and over 40
years
as
control. Between the two age groups, sex ratio, symptom duration, preoperative CEA level, location of the tumor, AstlerColler modified Dukes classification, histologic grade of the tumor, number of metastatic lymph node, size of the tumor, amount
of
transfusion, presence of precancerous lesion and family history, postoperative complications and survival rate were compared and analysed.
@ES The results were as follows:
@EN 1) The percentage of patients under 40 was 16.0% of total 187 patients.
2) The mean of symptom duration was 6.1±5.6 months and 56.7% of the patients under 40 and 57.9% of patients over 40 were than 6 month.
3) The mean of preoperative CEA was 8.9±7.8ng/ml and CEA level in 63.6% of the patients under 40 and 75.2% of patients over than 2.5 ng/ml.
4) The location of mass was rectum (58.6%). sigmoid colon (17.2%), transverse colon (13.8%), right colon (6.9%), left colon (4.5%) in patients under 40. As compared with those over 40, right colon was lower and transeverse colon was higher
incidence
without significant statistical difference.
5) With modified Dukes stage, there were stage A (10%), stage B1 (6.7%), stage B2 (16.7%), stage C2 (43.3%), stage D (23.3%) in patients under 40. As compared with those over 40, stage D was higher incidence with statistical significance
(P<0.05).
6) In the histological classification, there were well differenciated (36.4%), moderately differenciated (31.8%), mucinous type (22.8%), poorly differenciated (4.5%), signet ring cell type (4.5%) in patients under 40. As compared with those over
40,
there was more incidence of mucinous type and signet-ring cell type adenocarcinoma significantly (P<0.05).
7) Lymph node metastasis was noted in 66.7% of patients under 40 and 52.2% in those over 40.
8) The size of mass was larger than 8 cm in 33.3% of patients under 40 nd in 9.4% of patients over 40. (P<0.05).
9) The 70.0% of patients under 40 was received blood transfusion.
10) Two patients under 40 had familial polyposis and two patients had history of colorectal cancers among familial members.
11) Postoperative complication were ARF, internal hernia, colostomy stenosis, and pneumonia in patients under 40.
12) The 5-year survival rate was 35.0% in patients under 40 and 50.2% in those over 40 (p<0.05).
As a result of this study, the patients under 40 have high incidence of stage D and mucinous type adenocarcinoma. Se the overall survival of the patients under 40 was poor.
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