Differences in treatment and survival in young and elderly patients with colorectal cancer

INTRODUCTION. The incidence of colorectal cancer (CRC) in patients <= 40 years of age seems to follow an increasing trend worldwide. Previous studies have reported conflicting data on treatment intensity and survival in young patients with CRC. The aim of this study was to describe treatment and survival data in a national cohort of young Danish CRC patients in the 2001-2013 period and to compare these data with data on a national cohort of elderly patients with CRC. METHODS. In a retrospective study design, we analysed data on pre-operative management, treatment and overall survival in a national cohort of 484 young (18-40 years) and 14,647 elderly (66-75 years) CRC patients. Cox regression models were used to calculate adjusted hazard functions of overall survival. RESULTS. Surgical treatment did not differ markedly between age groups, but young patients received more oncological treatment and had a better stage-specific five-year overall survival than elderly patients. In an adjusted model, the hazard ratio for young patients with stage I-III disease was 0.67 (95% confidence interval (CI): 0.48-0.95) for colon cancer; 0.61 (95% CI: 0.37-0.99) for rectal cancer. CONCLUSION. Despite more advanced clinical stages of disease, young CRC patients had a better survival than elderly CRC patients in this national cohort. TRIAL REGISTRATION. The project was approved by DCCG (2013-03), the Danish Data Protection Agency (2008-58-0035) and the Regional Scientific Ethical Committee for Southern Denmark (S-20130079).