THE PROGNOSIS OF COLORECTAL CANCER IN YOUNGER PATIENTS Mohamed Zied Ben Abdessalem, Amine Gouader, Mohamed Salah Jarrar, Fatma medhioub, Mohamed Hedi Mraidha, Amine Elghali, Rafik ghrissi, Fehmi Hamila, Rached Letaief Department of General and Digestive Surgery - Farhat Hached University Hospital of Sousse - TUNISIE

INTRODUCTION Colorectal cancer (CRC) incidence has decreased over the past three decades, due largely to screening efforts. The CRC incidence and mortality rates are decreasing among all age groups older than 50 years, yet increasing in younger individuals for whom screening use is limited and key symptoms may go unrecognized. We describe incidence and mortality trends, clinical characteristics, and outcomes of CRC in individuals younger than 50 years. We aim to raise awareness of young-onset CRC.

METHODS Data were obtained from a retrospective database at Farhat Hached Hospital. There were 266 newly diagnosed patients with CRC from 2004 to 2014. Two extreme age groups, younger (>50 years) and elderly (<50 years), were analyzed to compare clinicopathologic characteristics and prognosis after exclusion of specific cancer syndrome.

RESULTS The younger group consisted of 67 patients with mean age of 41 years, and the elderly group consisted of 199 patients with mean age of 69.6 years. Younger patients had a more advanced disease (80.6%% vs 54.4%; p=0.001) and more lymph node involvement (67.7% vs 46.5%; p=0.004), higher incidence of mucinous cell type (29.7% vs 10.3%; p<0.005), poorly differentiated adenocarcinoma (14.3% vs 4.1%; p=0.007), and poorer disease-free survival (53.7% vs 71.2%; p=0.048), than elderly patients.

CONCLUSION Younger patients, without relevant predisposing risk factors, have more advanced stages of disease, more aggressive histopathologic characteristics, and poorer prognoses compared with older patients