Analysis of survival trends, clinical, and molecular characteristics of patients with early-onset colorectal cancer (EOCRC).

Abstract

59 Background: Over the last decades the incidence of EOCRC (age 50 or less) has dramatically increased, and so has the scientific interest in this field, given that clinical and molecular characteristics in these patients are not well understood, and may be critical to identify prognostic factors. Methods: We conducted a retrospective analysis of 554 patients with metastatic colorectal cancer (mCRC), analyzing the PFS and OS of 68 (12.25%) patients with EOCRC, as well as their clinical and molecular characteristics. We used a log-rank test to compare PFS and OS, and the estimate of hazard ratio (HR) between the studied groups was calculated by means of Cox proportional hazard model. We also used the exact test of Fisher to identify significant association between categoric variants, while Mann-Whitney test was applied to identify significant differences between numeric values. Results: We performed a survival analysis: those patients with EOCRC had significantly higher median PFS in first line of treatment (16.2 vs. 11.3 months, p = 0.042) and significantly higher median OS (121.5 vs. 58.1 months, p = 0.011). Several characteristics were significantly more frequent in patients with EOCRC (n=68): BMI < 18.5 (n = 16, OR = 1.9, p = 0.046), primary tumor site at transverse colon (n = 9, OR = 2.61, p = 0.03) and ECOG 0 (n = 32, OR = 2.21, p = 0.003). Having peritoneal metastases almost reached statistical signification (n = 17, OR = 1.82, p = 0.055). Some other characteristics were less frequent: BMI 25-30 (n = 13, OR = 0.51, p = 0.046), primary tumor site at sigmoid colon (n = 14, OR = 0.49, p = 0.038) and former-smoker status (n = 7, OR = 0.44, p = 0.048). Moreover, mean values of LDH at diagnosis were significantly higher in EOCRC patients (359 U/L vs. 280 U/L, p = 0.015). EOCRC patients received a significantly higher number of lines of chemotherapy (2.94 vs. 2.38, p = 0.027) and underwent more surgeries (2,42 vs. 1.24, p < 0,001) than patients with > 50 years. Significant differences in tumor mutational status (BRAF, KRAS, NRAS, MSI, PI3K and HER2), sex, primary tumor resection or number of metastatic sites between groups were not found. Conclusions: This retrospective analysis showed that EOCRC patients had significant higher rates of PFS in first-line treatment and OS. Moreover, EOCRC patients had more frequently BMI < 18.5, primary tumor located at transverse colon and ECOG 0.

Early Onset Metastatic Colorectal Cancer: Current Insights and Clinical Management of a Rising Condition

“…Nevertheless, in clinical practice, the age at diagnosis might influence physicians’ decision-making. Considering that younger patients tend to have better performance status and fewer comorbidities, the evidence shows that EOCRC is likely to receive more aggressive treatment, with conflicting data on the potential prognostic advantages [ 81 , 121 , 122 ]. An American cohort study involving 13,102 EOCRC patients (18 to 49 years) and 37,007 LOCRC patients (65 to 75 years) treated with curative-intent surgery and adjuvant chemotherapy reported that Stage IV CRC patients younger than 40 tended to undergo more systemic therapy and radiation with minimal survival gain (relative risk 0.84; 95% CI 0.79–0.90) [ 81 ].…”

“…A recent analysis of 554 mCRC patients showed that EOCRC patients (≤50 years) received more lines of chemotherapy (2.94 vs. 2.38, p = 0.027) and underwent more surgeries (2.42 vs. 1.24; p < 0.001) than their older counterparts. Furthermore, the younger cohort demonstrated better survival in first-line treatment (mPFS 16.2 vs. 11.3 months, p = 0.042; mOS 121.5 vs. 58.1 months, p = 0.011) [ 122 ]. Other data suggested no significant difference in the recurrence rate in radically resected Stage III and IV young patients (27.5% vs. 27.9%, p = 0.325), even though they had more advanced stages at diagnosis (55.6% vs. 47.9%, p = 0.001) and worse cancer-specific survival (81.2% vs. 87.8%, p < 0.001) [ 123 ].…”