Gastrointestinal Cancer

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SU_5_2044 - Evaluation of Patient Characteristics, Treatment Decisions and Survival of Young Patients Under The Age of 50 Diagnosed With Colorectal Carcinoma.

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Evaluation of Patient Characteristics, Treatment Decisions and Survival of Young Patients Under The Age of 50 Diagnosed With Colorectal Carcinoma.
M. R. Thompson1, S. Lazarev1, S. Pintova2, P. Sylla3, C. Ang2, U. Sarpel3, R. Steinhagen3, D. Solomon3, D. Labow3, and M. Buckstein4; 1Icahn School of Medicine at Mount Sinai Department of Radiation Oncology, New York, NY, 2Icahn School of Medicine at Mount Sinai Department of Medical Oncology, New York, NY, 3Icahn School of Medicine at Mount Sinai Department of Surgery, New York, NY, 4Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY

Purpose/Objective(s): Recent reports have demonstrated an increase in the incidence of young people (under age 50) diagnosed with colorectal carcinoma (CRC). In this retrospective study we aimed to examine clinical presentation, treatment decisions and overall survival in this population seen within a large metropolitan health system.

Materials/Methods: We reviewed records of patients diagnosed with CRC before the age of 50 between 2012 and 2017. Variables included presenting symptoms, length of follow up, treatment modalities, pathological findings and molecular studies. The primary study endpoint was overall survival. Survival was examined using the Kaplan-Meier method and log rank test.

Results: Fifty patients were identified with median age at diagnosis of 41 (range 25-49). Twenty-seven patients (54%) were male. Median follow up from diagnosis was 23 months (range 0-77). Six patients (12%) had stage I, 12 (24%) stage II, 19 (38%) stage III and 13 (26%) stage IV disease. Of the stage IV patients, 8 (16%) presented with liver metastases and 4 (8%) presented with peritoneal disease and underwent HIPEC. Other metastatic sites included lung and vertebral body. Four patients (8%) had a history of IBD. Most common presenting symptoms included rectal bleeding (58%), pain (36%) and change in bowel habits (38%). Patients experienced symptoms for a medium of 3 months prior to diagnosis (range 0-13 months). Primary histology was adenocarcinoma (82%). Disease sites included rectum in 31 (62%), sigmoid in 11 (22%) and colon in 8 (16%) patients. Most underwent chemotherapy; 28 (56%) neoadjuvant and 22 (44%) adjuvant. Twenty-six patients (52%) underwent neoadjuvant chemoradiation (CRT), 1 (2%) definitive CRT and 2 (4%) consolidative CRT following recurrence. Forty patients (80%) underwent surgical resection; 20 (40%) had LAR and 3 (6%) had surgery as their only treatment. Molecular studies were available for 26 patients (52%), 15 of which were KRAS+. Microsatellite status was available for 49 (98%) patients. Of these, 48 (96%) were microsatellite stable and only 1 (2%) patient had a loss of MSH2 and MSH6. At the time of analysis, a total of 5 (10%) deaths were recorded, all due to the underlying malignancy. The 2- and 4-year actuarial overall survival (OS) rates for the entire cohort were 97.5% and 78.8%, respectively. Overall survival stratified by stage is available in Table 1. There was no difference in OS between different stages (p=0.47).

Conclusion: In the present study, the majority of patients (64%) presented with advanced stages of CRC. Short-term overall survival for the entire cohort was favorable. It is notable that patients in this cohort with stage IV disease had an extended overall survival of 75% at 4 years. Further research is needed to better characterize CRC in this unique patient population to tailor treatment approaches to improve survival. Table 1
Overall Survival 2 years 4 years
Stage I 100% 100%
Stage II 100% 100%
Stage III 100% 67%
Stage IV 90% 75%

Author Disclosure: M.R. Thompson: None. S. Lazarev: None. S. Pintova: Advisory Board; Celgene. P. Sylla: None. C. Ang: None. U. Sarpel: None. M. Buckstein: None.

Marcher Thompson, MD

Biography:
Marcher R Thompson M.D. is Chief Resident of the Radiation Oncology Department at the Mount Sinai Hospital. She was born in Trinidad and Tobago but moved to Roswell, GA at the age of 9. She received her undergraduate degree in Ecology and Evolutionary Biology from Princeton University and completed medical training at the University of Pittsburgh School Of Medicine. Prior to graduation she spent a research year in Dr. Simon Powell's lab at Memorial Sloan Kettering exploring the mechanism of defects in double strand break repair with homologous recombination. She then completed a transitional year internship at Emory University Hospital prior to starting residency at the Mount Sinai Hospital. Her clinical and research interests include thoracic oncology and translational research.

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