Are Pediatric Patients More Likely to Die from Colon Cancer Than Adults?

A new study compared mortality among pediatric and adult colon cancer patients. The researchers concluded that pediatric and young adult patients have poorer three- and five-year stage-for-stage overall survival (OS) and recurrence free (RFS) survival rates.

“Children with colon cancer can fall through the cracks. They may be seen by an oncologist who treats adults but who doesn’t know how to treat children. Or they may be seen by a pediatrician who knows all about treating children but nothing about colon cancer,” lead study author Andrea Hayes-Jordan, MD, FACS, and surgeon-in-chief of the North Carolina Children’s Hospital, University of North Carolina, Chapel Hill, in a press release.

The study retrospectively reviewed pediatric/adolescent colon cancer patients aged younger than 25 years who received treatment at the University of Texas MD Anderson Cancer Center between 1991 and 2017. These patients were compared to a group of adult patients obtained through a prospectively maintained database.

Final analysis included 94 pediatric patients and 765 adult patients. The three-year OS rate was 90.00% for the adult patietns compared to 41.92% for the pediatric patients; the three-year RFS rates were 78% and 32%, respectively.

Stage-for-stage, the five-year OS rates for the adult versus pediatric patients were: stage 1, 96% vs. 100% (P=0.793); stage 2, 90% vs. 64%(P<0.0001); stage 3, 85% vs. 58%(P<0.0001); and stage 4, 55% vs. 16% (P<0.0001). Stage-for-stage, the five-year RFS rates for the adult versus pediatric patients were: stage 1, 95% vs. 100%; stage 2, 85% vs. 55% (P=0.0002); stage 3, 73% vs. 31% (P<0.0001); and stage 4, 27% vs. 5% (P<0.0001).

Upon multivariate analysis, pediatric/adolescent patients, compared to adults, had a higher risk of recurrence or death (hazard ratio=2.312; 95% confidence interval, 1.615–3.313; P<0.0001). Pediatric patients also had a significantly higher rate of peritoneal metastasis (P=0. 00001).

“Although some may think the study raises more questions than it answers, it at least illuminates the problem so we can start working on it,” said Dr. Hayes-Jordan. She added, “Children are not small adults. They should be treated with independent thought and careful evaluation.”

In their study, published in the Journal of the American College of Surgeons, Dr. Hayes-Jordan and colleagues concluded, “Stage-for-stage, pediatric/adolescent patients had shorter 3- and 5-year OS and RFS rates than adult patients. Peritoneal disease and carcinomatosis was significantly higher in pediatric, adolescent and young adult patients less than 25 years. Pre-disposing conditions such as polyposis or congenital colon disease did not contribute to this difference.”