Colorectal carcinoma in pediatric patients: A comparison with adult tumors, treatment and outcomes from the National Cancer Database

doi:10.1016/j.jpedsurg.2015.11.005

Journal of Pediatric Surgery

Volume 51, Issue 7, July 2016, Pages 1061-1066

https://doi.org/10.1016/j.jpedsurg.2015.11.005 Get rights and content

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.

Study Design

CRC patients in the National Cancer Data Base from 1998 to 2011, were grouped into Pediatric (≤ 21 years), early onset adult (22–50) and older adult (> 50) patients. Groups were compared with χ² 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 5 years 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.

Section snippets

Methods

Ethical approval for this study was granted by the Maine Medical Center Institutional Review Board. All patients with a histologic diagnosis of colorectal adenocarcinoma, using ICD-O-3 classification, diagnosed between years 1998 and 2011 were identified from the NCDB. The NCDB, a joint project of the American Cancer Society and the Commission on Cancer (CoC) of the American College of Surgeons, is a nationwide, facility-based, comprehensive clinical surveillance resource oncology data set that

Demographics (Table 1)

A total of 918 pediatric (Ped), 157, 577 early onset adult (EA), and 1,303,655 older adult (OA) patients were identified (Fig. 1). There were no significant differences in gender or race among the 3 age groups. Comorbidities, as measured by the Charlson Deyo score, increased with increasing age. Significant differences exist in presenting location of tumor, with older adults presenting with a higher proportion of right colon cancer (Ped: 23.7%, EA: 22.9%, OA: 35.8%, p < 0.001) whereas the early

Discussion

To our knowledge, the current study represents the largest cohort (N = 918) of pediatric colorectal cancer patients studied. These results reveal poorer survival in children, even when adjusted for known prognostic factors such as stage, pathology, and behavior. Notably, the mortality risk associated with the pediatric age group was affected by the tumor location, with a greater effect on mortality for rectal tumors. This study also confirms findings from prior studies demonstrating more

Conclusions

To our knowledge, this study represents the largest cohort of pediatric CRC patients and confirms more aggressive tumor histology and behavior in children, even with standard oncologic treatment in younger patients. This presentation is associated with a higher 5 year mortality in pediatric patients when compared to the adult cohorts. Poorer outcomes in pediatric CRC patients appear to be owing to worse tumor biology and stage rather than treatment disparities. Furthermore colon and rectal

Acknowledgment

Jeremy Kane, PhD for help with statistical analysis.

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Original ArticleColorectal carcinoma in pediatric patients: A comparison with adult tumors, treatment and outcomes from the National Cancer Database

Abstract

Background

Study Design

Results

Conclusions

Section snippets

Methods

Demographics (Table 1)

Discussion

Conclusions

Acknowledgment

Mayo Clin Proc

Am J Surg

J Am Coll Surg

Distinct features of colorectal cancer in children and adolescents: a population-based study of 159 cases

Cancer

Colorectal carcinoma in childhood and adolescence: a clinicopathologic review

J Clin Oncol

Unique characteristics of adolescent and young adult acute lymphoblastic leukemia, breast cancer, and colon cancer

J Natl Cancer Inst

Management of colorectal carcinoma in children and young adults

J Pediatr Hematol Oncol

Prognostic factors and outcome in patients 21 years and under with colorectal carcinoma

J Pediatr Surg

Young-onset colorectal cancer: is it time to pay attention?

Arch Intern Med

The national cancer data base: past, present, and future

Ann Surg Oncol

Systematic review of comorbidity indices for administrative data

Med Care

Concordance probability and discriminatory power in proportional hazards regression

Biometrika

Colorectal carcinoma in childhood: a retrospective multicenter study

J Pediatr Gastroenterol Nutr

Molecular genetic alterations and clinical features in early-onset colorectal carcinomas and their role for the recognition of hereditary cancer syndromes

Am J Gastroenterol

Human cancer syndromes: clues to the origin and nature of cancer

Science

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Gut

Original Article
Colorectal carcinoma in pediatric patients: A comparison with adult tumors, treatment and outcomes from the National Cancer Database