Background: The risk of lymph node positivity in early-stage colon cancer is a parameter that impacts therapeutic\nrecommendations. However, little is known about the effect of age on lymph node positivity in colon cancer with\nmucosal invasion. In this study, we aimed to quantify the effect of younger age on lymph node positivity in colon\ncancer with mucosal invasion.\nMethods: All patients were identified between 2004 and 2014 in the Surveillance, Epidemiology, and End Results\ndatabase. Patients were stage T1-T2, did not undergo preoperative radiotherapy, had at least one lymph node\nexamined, and underwent a standard colon cancer operation. Demographics and pathological data were compared\nbetween different age ranges. A nomogram model was built to estimate the probability of nodal involvement\naccording to different characteristics. Decision curve analysis was performed by calculating the net benefits for a\nrange of threshold probabilities.\nResults: This study identified 41,490 patients who met the eligibility criteria for our study. 1.4% (n = 620) of patients\nwere under 40 years old; 5.9% (n = 2571) were between 40 and 49 years old. Within each T stage, positive lymph\nnode rates decreased with increasing age. In univariate analyses, the positive lymph node rates for patients 20 to\n39 years of age were significantly higher than in patients in the reference group for stages T1 and T2. After dividing\nthe colon into the left and right parts, these trends remained. The lymph node metastatic rate was higher in the\nright colon than in the left colon in terms of different age ranges. The nomogram prediction system represents a\nnovel model with which to estimate lymph node metastasis in early T stage colon adenocarcinomas based on four\nrisk factors with a C-index of 0.657 (95% CI: 0.658â??0666).\nConclusions: Our study demonstrates that the risk of lymph node metastasis was higher in young (< 40 years)\npatients with early-stage colon adenocarcinomas. Therefore, more aggressive screening and therapeutic strategies\nshould be considered for young patients with colon adenocarcinoma.
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