Skip to main content

Advertisement

SpringerLink
Log in

Predictive value of initial imaging and staging with long-term outcomes in young adults diagnosed with colorectal cancer

  • Hollow Organ GI
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate how initial abdominopelvic CT findings and staging correlate with outcomes in a cohort of patients aged 18–40 years.

Methods

We evaluated all young adult patients at a single tertiary center diagnosed with histopathologically confirmed CRC who also had CT of the abdomen and pelvis at the time of initial diagnosis. Demographics, symptoms, CT findings, staging, treatments, and outcomes at 1 year and 5 years were recorded.

Results

Of 91 patients who met initial inclusion criteria, 81.8% had a mass present on CT, with an average size of 4.8 cm ± 2.9. A majority of patients were surgical stage III or IV (64.3%). Advanced AJCC stage was more common with rectal tumors and metastatic disease on initial CT (p < 0.0001). In a subgroup analysis, almost all patients initially staged 4A or higher had progression of disease. At the final follow-up visit, by RECIST 1.1 criteria, 58.8% had progressive disease, 35.3% complete response, and 3.9% stable disease. The overall 5-year survival rate in this subgroup was 40% with lower survival probability with increasing stage (p = 0.0001).

Conclusion

Most young adult patients presented with large tumors on imaging, increasing the likelihood of identification on CT. Tumors initially presenting in the rectum with enlarged lymph nodes and/or with distant metastases on CT were more often associated with advanced surgical stage and poorer prognosis. A majority of patients presented at an advanced stage, most commonly stage 4A, and had progression of disease at follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. CA Cancer J Clin 66 (1):7-30. https://doi.org/10.3322/caac.21332

    Article  PubMed  Google Scholar 

  2. Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, Stein KD, Alteri R, Jemal A (2016) Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 66 (4):271-289. https://doi.org/10.3322/caac.21349

    Article  PubMed  Google Scholar 

  3. Mokdad AH, Dwyer-Lindgren L, Fitzmaurice C, Stubbs RW, Bertozzi-Villa A, Morozoff C, Charara R, Allen C, Naghavi M, Murray CJ (2017) Trends and Patterns of Disparities in Cancer Mortality Among US Counties, 1980-2014. JAMA 317 (4):388-406. https://doi.org/10.1001/jama.2016.20324

    Article  PubMed  PubMed Central  Google Scholar 

  4. Siegel RL, Miller KD, Fedewa SA, Ahnen DJ, Meester RGS, Barzi A, Jemal A (2017) Colorectal cancer statistics, 2017. CA Cancer J Clin 67 (3):177-193. https://doi.org/10.3322/caac.21395

    Article  PubMed  Google Scholar 

  5. Ozel B, Pickhardt PJ, Kim DH, Schumacher C, Bhargava N, Winter TC (2010) Accuracy of routine nontargeted CT without colonography technique for the detection of large colorectal polyps and cancer, 2010 Dis Colon Rectum.53(6):911-918. https://doi.org/10.1007/DCR.0b013e3181d5de13

    Article  PubMed  Google Scholar 

  6. 6. Benson AB, 3rd, Venook AP, Cederquist L, Chan E, Chen YJ, Cooper HS, Deming D, Engstrom PF, Enzinger PC, Fichera A, Grem JL, Grothey A, Hochster HS, Hoffe S, Hunt S, Kamel A, Kirilcuk N, Krishnamurthi S, Messersmith WA, Mulcahy MF, Murphy JD, Nurkin S, Saltz L, Sharma S, Shibata D, Skibber JM, Sofocleous CT, Stoffel EM, Stotsky-Himelfarb E, Willett CG, Wu CS, Gregory KM, Freedman-Cass D (2017) Colon Cancer, Version 1.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 15 (3):370-398. https://doi.org/10.6004/jnccn.2017.0036

    Article  CAS  PubMed  Google Scholar 

  7. Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Levin TR, Lieberman D, Robertson DJ (2017) Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 112 (7):1016-1030. https://doi.org/10.1038/ajg.2017.174

    Article  PubMed  Google Scholar 

  8. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45 (2):228-247. https://doi.org/10.1016/j.ejca.2008.10.026

    Article  CAS  PubMed  Google Scholar 

  9. Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17 (6):1471-1474. https://doi.org/10.1245/s10434-010-0985-4

    Article  PubMed  Google Scholar 

  10. Bailey CE, Hu CY, You YN, Bednarski BK, Rodriguez-Bigas MA, Skibber JM, Cantor SB, Chang GJ (2015) Increasing disparities in the age-related incidences of colon and rectal cancers in the United States, 1975-2010. JAMA Surg 150 (1):17-22. https://doi.org/10.1001/jamasurg.2014.1756

    Article  PubMed  PubMed Central  Google Scholar 

  11. Tricoli JV, Boardman LA, Patidar R, Sindiri S, Jang JS, Walsh WD, McGregor PM, 3rd, Camalier CE, Mehaffey MG, Furman WL, Bahrami A, Williams PM, Lih CJ, Conley BA, Khan J (2018) A mutational comparison of adult and adolescent and young adult (AYA) colon cancer. Cancer 124 (5):1070-1082. https://doi.org/10.1002/cncr.31136

    Article  CAS  PubMed  Google Scholar 

  12. Gausman V, Dornblaser D, Anand S, Hayes RB, O'Connell K, Du M, Liang PS (2019) Risk Factors Associated With Early-Onset Colorectal Cancer. Clin Gastroenterol Hepatol. https://doi.org/10.1016/j.cgh.2019.10.009

    Article  PubMed  PubMed Central  Google Scholar 

  13. Levine O, Zbuk K (2019) Colorectal cancer in adolescents and young adults: Defining a growing threat. Pediatr Blood Cancer 66 (11):e27941. https://doi.org/10.1002/pbc.27941

    Article  PubMed  Google Scholar 

  14. Brouwer NPM, Bos A, Lemmens V, Tanis PJ, Hugen N, Nagtegaal ID, de Wilt JHW, Verhoeven RHA (2018) An overview of 25 years of incidence, treatment and outcome of colorectal cancer patients. Int J Cancer 143 (11):2758-2766. https://doi.org/10.1002/ijc.31785

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Kneuertz PJ, Chang GJ, Hu CY, Rodriguez-Bigas MA, Eng C, Vilar E, Skibber JM, Feig BW, Cormier JN, You YN (2015) Overtreatment of young adults with colon cancer: more intense treatments with unmatched survival gains. JAMA Surg 150 (5):402-409. https://doi.org/10.1001/jamasurg.2014.3572

    Article  CAS  PubMed  Google Scholar 

  16. Indini A, Bisogno G, Cecchetto G, Vitellaro M, Signoroni S, Massimino M, Riccipetitoni G, Zecca M, Dall'Igna P, De Pasquale MD, Inserra A, Chiaravalli S, Basso E, Virgone C, Sorbara S, Di Bartolomeo M, D'Angelo P, Ferrari A (2017) Gastrointestinal tract carcinoma in pediatric and adolescent age: The Italian TREP project experience. Pediatr Blood Cancer 64 (12). https://doi.org/10.1002/pbc.26658

    Article  Google Scholar 

  17. Mauri G, Sartore-Bianchi A, Russo AG, Marsoni S, Bardelli A, Siena S (2019) Early-onset colorectal cancer in young individuals. Mol Oncol 13 (2):109-131. https://doi.org/10.1002/1878-0261.12417

    Article  PubMed  Google Scholar 

  18. Hanna K, Zeeshan M, Hamidi M, Pandit V, Omesiete P, Cruz A, Ewongwo A, Joseph B, Nfonsam V (2019) Colon cancer in the young: contributing factors and short-term surgical outcomes. Int J Colorectal Dis 34 (11):1879-1885. https://doi.org/10.1007/s00384-019-03402-2

    Article  PubMed  Google Scholar 

  19. Burnett-Hartman AN, Powers JD, Chubak J, Corley DA, Ghai NR, McMullen CK, Pawloski PA, Sterrett AT, Feigelson HS (2019) Treatment patterns and survival differ between early-onset and late-onset colorectal cancer patients: the patient outcomes to advance learning network. Cancer Causes Control 30 (7):747-755. https://doi.org/10.1007/s10552-019-01181-3

    Article  PubMed  Google Scholar 

  20. Vatandoust S, Price TJ, Ullah S, Roy AC, Beeke C, Young JP, Townsend A, Padbury R, Roder D, Karapetis CS (2016) Metastatic Colorectal Cancer in Young Adults: A Study From the South Australian Population-Based Registry. Clin Colorectal Cancer 15 (1):32-36. https://doi.org/10.1016/j.clcc.2015.07.005

    Article  PubMed  Google Scholar 

  21. Rho YS, Gilabert M, Polom K, Aladashvili A, Kopeckova K, Megdanova V, Coleman N, Greally M, Marrelli D, Roviello F, McDermott R, Petrova V, Mihaylova Z, Bortlicek Z, Prausova J, Batist G, Azoulay L, Kavan P (2017) Comparing Clinical Characteristics and Outcomes of Young-onset and Late-onset Colorectal Cancer: An International Collaborative Study. Clin Colorectal Cancer 16 (4):334-342. https://doi.org/10.1016/j.clcc.2017.03.008

    Article  PubMed  Google Scholar 

  22. Wang R, Wang MJ, Ping J (2015) Clinicopathological Features and Survival Outcomes of Colorectal Cancer in Young Versus Elderly: A Population-Based Cohort Study of SEER 9 Registries Data (1988-2011). Medicine (Baltimore) 94 (35):e1402. https://doi.org/10.1097/MD.0000000000001402

    Article  Google Scholar 

  23. Abdelsattar ZM, Wong SL, Regenbogen SE, Jomaa DM, Hardiman KM, Hendren S (2016) Colorectal cancer outcomes and treatment patterns in patients too young for average-risk screening. Cancer 122 (6):929-934. https://doi.org/10.1002/cncr.29716

    Article  PubMed  Google Scholar 

  24. Khan SA, Morris M, Idrees K, Gimbel MI, Rosenberg S, Zeng Z, Li F, Gan G, Shia J, LaQuaglia MP, Paty PB (2016) Colorectal cancer in the very young: a comparative study of tumor markers, pathology and survival in early onset and adult onset patients. J Pediatr Surg 51 (11):1812-1817. https://doi.org/10.1016/j.jpedsurg.2016.07.015

    Article  PubMed  PubMed Central  Google Scholar 

  25. Al-Barrak J, Gill S (2011) Presentation and outcomes of patients aged 30 years and younger with colorectal cancer: a 20-year retrospective review. Med Oncol 28 (4):1058-1061. https://doi.org/10.1007/s12032-010-9639-4

    Article  PubMed  Google Scholar 

  26. Solinas C, Porcu M, Hlavata Z, De Silva P, Puzzoni M, Willard-Gallo K, Scartozzi M, Saba L (2017) Critical features and challenges associated with imaging in patients undergoing cancer immunotherapy. Crit Rev Oncol Hematol 120:13-21. https://doi.org/10.1016/j.critrevonc.2017.09.017

    Article  PubMed  Google Scholar 

Download references

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Department of Radiology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 210, MSC 323, Charleston, SC, 29425, USA

    Jeremy R. Burt, Jeffrey Waltz, Andres Abadia, Basel Yacoub, Sydney A. Burt & Madison R. Kocher

  2. School of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA

    Ashley Ramirez

  3. Department of Internal Medicine, Canton Medical Education Foundation, 2600 6th St SW, Canton, OH, 44710, USA

    Fiona Tissavirasingham

Authors
  1. Jeremy R. Burt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeffrey Waltz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ashley Ramirez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andres Abadia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Basel Yacoub
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sydney A. Burt
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fiona Tissavirasingham
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Madison R. Kocher
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JRB—Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Project administration; Resources; Supervision; Validation; Visualization; Roles/Writing—original draft; Writing—review & editing. JW—Formal analysis; Investigation; Visualization; Writing—review & editing. AR—Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Writing—review & editing. AA—Methodology; Validation; Writing—review & editing. BY—Methodology; Validation; Writing—review & editing. SAB—Validation; Writing—review & editing. FT—Data curation; Investigation; Writing—review & editing. MRK—Formal analysis; Investigation; Methodology; Project administration; Supervision; Validation; Visualization; Roles/Writing—original draft; Writing—review & editing.

Corresponding author

Correspondence to Jeremy R. Burt.

Ethics declarations

Conflict of interest

All the authors declared that they have no conflict of interest.

Ethical approval

This study protocol was approved by the AdventHealth Orlando Institutional Review Board (IRB # 1165067-15) and Office of Sponsored Projects. It was performed in compliance with the Health Insurance Portability and Accountability Act (HIPAA).

Informed consent

The protocol was granted a waiver of the need for informed consent due to the study’s retrospective nature and involvement of no more than minimal risk to patients.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Burt, J.R., Waltz, J., Ramirez, A. et al. Predictive value of initial imaging and staging with long-term outcomes in young adults diagnosed with colorectal cancer. Abdom Radiol 46, 909–918 (2021). https://doi.org/10.1007/s00261-020-02727-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-020-02727-9

Keywords

Search

Navigation