PURPOSE: This study was designed to investigate whether characteristics, prognostic risk factors, and survival of colorectal cancer of Japanese-Americans in Hawaii are different from those of native Japanese in Japan. METHODS: A retrospective review of patients with colorectal cancer surgically resected in single institutions in Hawaii and Japan from 1996 to 2002. RESULTS: A total of 410 Japanese-American patients (218 males; median age, 73 years) and 621 native Japanese patients (382 males; median age, 65 years) were included. There were significant differences in age (P < 0.001), age distribution (P < 0.001), gender (P= 0.008), preoperative carcinoembryonic antigen (P < 0.001), and anatomic site distribution (P < 0.001). The tumor characteristics of Japanese- American patients were close to the general American population compared with the Surveillance, Epidemiology, and End Results data. There were no differences in tumor size, histologic grade, each of T, N, M status and TNM stage between the two groups. The overall five-year survival rates (Japanese-Americans, 75.5 percent; native Japanese, 76.2 percent; P = 0.55) and survival rates in each of four stratified stages were similar. Risk factors associated with survival were not different, except for carcinoembryonic antigen (P = 0.036). CONCLUSIONS: In patients with colorectal cancer in Japanese-Americans in Hawaii, some of tumor characteristics have changed from those of native Japanese in Japan. However, there are no remarkable differences in prognostic factors and survival between the two groups. The present study suggests that certain changes of colorectal cancer characteristics that were seen in Japanese-American may occur in native Japanese in Japan in the near future, although the survival-outcome of colorectal cancer may remain the same. METHODS: A retrospective review of patients with colorectal cancer surgically resected in single institutions in Hawaii and Japan from 1996 to 2002. RESULTS: A total of 410 Japanese-American patients (218 males; median age, 73 years) and 621 native Japanese patients (382 males; median age, 65 years) were included. Significant differences in age (P <0.001), age distribution (P <0.001), gender (P = 0.008), preoperative carcinoembryonic antigen (P <0.001), and anatomic site distribution American patients were close to the general American population compared with the Surveillance, Epidemiology, and End Results data. There were no differences in tumor size, histologic grade, each of T, N, M status and TNM stage The overall five-year survival rates (Japanese-Americans, 75.5 percent; native Japanese, 76.2 percent; P = 0.55) and survival rates in each of the four stratified stages were similar. Risk factors associated with survival were not different , except for carcinoembryonic antigen (P = 0.036). CONCLUSIONS: In patients with colorectal cancer in Japanese-Americans in Hawaii, some of the tumor characteristics have changed from those of native Japanese in Japan. However, there are no remarkable differences in prognostic factors and the present study suggests that certain changes of colorectal cancer characteristics that were seen in Japanese-American may occur in native Japanese in Japan in the near future, although the survival-outcome of colorectal cancer may remain the same.