Overtreatment of young adults with colon cancer: more intense treatments with unmatched survival gains.

摘要: Importance Colon cancer is increasing among adults younger than 50 years. However, the prognosis of young-onset colon remains poorly defined given significant age-related demographic, disease, and treatment differences. Objective To define stage-specific treatments diagnosed in young (ages 18-49 years) vs older 65-75 outside clinical trial setting while accounting for real-world variations patient, tumor, factors. Design, Setting, Participants A nationwide cohort study was conducted US hospitals accredited by American College Surgeons Commission on Cancer. were 13 102 patients as having adenocarcinoma aged 18 to 49 years 37 007 later-onset 65 75 treated between January 1, 2003, December 31, 2005, reported National Cancer Data Base. Exposures Patients who underwent surgical resection postoperative systemic chemotherapy curative intent. Main Outcomes Measures The primary end point relative survival, an objective measure survival with cancer, adjusting baseline mortality rates independent data cause death. secondary likelihood receiving chemotherapy. Results Most initially seen at advanced stages (61.8% had stage III or IV). After patient-related tumor-related factors, more likely receive chemotherapy, particularly multiagent regimens, all those disease. These odds ratios 2.88 (95% CI, 2.21-3.77) I, 3.93 3.58-4.31) II, 2.42 2.18-2.68) III, 2.74 2.44-3.07) IV. significantly intense received unmatched any gain, which nil II (relative risk, 0.90; 95% 0.69-1.17) marginal 0.89; 0.81-0.97) IV 0.84; 0.79-0.90). Conclusions Relevance Young stages, but they experienced only minimal gain adjusted compared their counterparts less treatment. This mismatch suggests that attention should be long-term survivorship because face needs are distinct from counterparts.