Patients under 40 appear to have more aggressive liver tumors from colorectal cancer and poorer long-term outcomes.
After surgery to remove the cancer that had spread to their liver, patients who were 40 or younger had poorer overall survival and shorter time until cancer returned.
The percentage of younger patients who were alive without cancer five years later was similar to older patients, which the research team attributed to more aggressive treatment for the young patients, along with repeated surgery.
All patients who had surgery to remove colorectal cancer that had spread to their livers (liver resection) at the French Hôpital Paul Brousse from 1990 through 2006 were studied. 56 of 806 (7 percent) were 40 years old or younger.
They had more liver metastases when they were diagnosed than older patients, and liver tumors were more often found at the same time as their primary tumor in colon or rectum.
Comparing younger and older patients:
- Half of older patients (51 percent) were alive at five years (overall survival) compared to a third (33 percent) of the younger ones.
- Only 2 percent of young patients didn’t have cancer get worse during the five years after surgery (progression-free survival) compared to 16 percent of older ones.
- Disease-free survival at five years was similar in both groups (17 percent for young, 23 percent for older.)
- Being 40 or younger independently predicted poor progression-free survival.
Robbert J. de Haas, MD and his colleagues concluded,
In young patients, colorectal liver metastases seem to be more aggressive, with a trend toward lower overall survival, more disease recurrences, and a significantly shorter progression-free survival after hepatectomy. However, disease-free survival rates were comparable between young and older patients, owing to an aggressive multimodality treatment approach, consisting of chemotherapy and repeat surgery. Therefore, physicians should recognize the poor outcome of colorectal liver metastases in young patients and should consider an aggressive approach to diagnosis and early treatment.