mar
Ida Gutlic- Institutionen för kliniska vetenskaper, Malmö
Title: Colorectal cancer in patients < 50 years
Main supervisor: Pamela Buchwald
Reviewers: docent David Ljungman Göteborg Universitet, docent Bodil Andersson Lund Universitet
Abstract
Background
Colorectal cancer (CRC) is the third most common malignancy in Sweden after breast and prostate cancer. It is considered a disease that affects the older population, but the incidence of CRC in Sweden is increasing in individuals < 50 years.
Aim
The aim of the projects is to closer study CRC from an age perspective by determining trends regarding CRC incidence and tumour localization in Sweden and further examine differences in postoperative 30-days complications, emergency surgeries, follow-up after CRC-surgery as well as histopathological characteristics in CRC-patients < 50 years compared to older age-groups.
Methods
Paper 1: Data from the National Board of Health and Welfare between 1995-2015 were used. Poisson regression was used to analyse CRC-incidence by age (< 50, 50-79 and ≥ 80 years), gender, tumour localization (proximal-, distal- and rectal cancer) and time.
Paper 2: Population-based data from the Swedish Colorectal Cancer Registry for patients undergoing CRC resection between 2010-2018 were utilsed. Bivariate analysis and logistic regression were used to analyse the relationship between age-groups (< 50, 50-79 and ≥ 80 years) to investigate the probability of postoperative 30-days complications adjusted for gender, tumour localization, neoadjuvant radio-chemotherapy and ASA-score.
Paper 3: The COLOFOL database between 2006-2010 was used to analyse patients that were randomized to high-frequency versus low-frequency follow-up after curative CRC-surgery. Intention-to-treat and per-protocol analyses were preformed to study 5-year overall mortality, cancer-specific mortality and recurrence comparing the age-groups ≤ 50, 51-70 and > 70 years. Adjusted hazard ratios (HR) were calculated using cox-regression analysis.
Results
Paper 2: In total 33,320 patients were included. CRC-patients < 50 years had lower overall postoperative 30-days complications ORadj 0.84 (95% CI 0.74-0.96) compared to those aged ≥ 80 years. Surgical complications were more common in age-groups < 50 years and 50-79 years (16.5 and 16.9 percent respectively) compared to patients ≥ 80 years (14.1 percent) (p < 0.001).
Paper 3: In total 2509 patients were included in the intention-to-treat analysis. The 5-year overall mortality rate for patients < 50 years in the high-frequency group was 8.3 percent compared with 8.4 percent in the low-frequency group (risk difference, 0.16 percent [95% CI, −8.0 - 8.3]). The cancer-specific mortality rate for patients < 50 years in the high-frequency group was 7.1 percent compared with 7.4 percent in the low-frequency group (risk difference, 0.28 percent [95% CI, -7.4 - 8.0]). The cancer-specific recurrence rate for patients < 50 years in the high-frequency group was 12.9 percent compared with 21.0 percent in the low-frequency group (risk difference, 8.1 percent [95% CI, -2.6 - 18.7]). When adjusting for confounders the 5-year overall mortality HR, cancer-specific mortality HR and cancer-specific recurrence HR for patients < 50 years in the high-frequency group was 1.2 (95% CI 0.4 - 3.5), 1.3 (95% CI 0.4 – 4.4) and 0.7 (95% CI 0.3 – 1.5) respectively when compared to the low frequency group.
Significance
The incidence of CRC in individuals < 50 years is rising. This trend may lead to large consequences for the health care system. There are not many studies on CRC from an age-perspective. Our results contribute to better understanding of CRC in younger patients.
Publications
Gutlic I, Schyman T, Lydrup ML, Buchwald P. Increasing colorectal cancer incidence in individuals aged < 50 years – a population-based study. Int J Colorectal Dis 2019;7: 1221-6.
Gutlic I, Saraste D, Nordenvall C, Martling A, Lydrup ML, Buchwald P. Postoperative complications and emergency surgeries in colorectal cancer patients < 50 years – a national cohort study (submitted 2023).
Om evenemanget
Plats:
Kirurgens bibliotek SUS Malmö, plan 3
Kontakt:
gutlic [dot] ida [at] gmail [dot] com