Care Patterns and Overall Survival in Patients With Early-Onset Metastatic Colorectal Cancer

Abstract

PURPOSE: Colorectal cancer (CRC) incidence in patients younger than 50 years of age, commonly defined as early-onset (EO-CRC), is rising. EO-CRC often presents with distinct clinicopathologic features. However, data on prognosis are conflicting and outcomes with modern treatment approaches for metastatic disease are still limited. MATERIALS AND METHODS: We prospectively enrolled patients with metastatic CRC (mCRC) to a biobanking and clinical data collection protocol from 2014 to 2018. We grouped the cohort based on age at initial diagnosis: < 40 years, 40-49 years, and ≥ 50 years. We used regression models to examine associations among age at initial diagnosis, treatments, clinicopathologic features, and survival. RESULTS: We identified 466 patients with mCRC (45 [10%] age < 40 years, 109 [23%] age 40-49 years, and 312 [67%] age ≥ 50 years). Patients < 40 years of age were more likely to have received multiple metastatic resections (odds ratio [OR], 3.533; P = .0066) than their older counterparts. Patients with EO-CRC were more likely to receive triplet therapy than patients > 50 years of age (age < 40 years: OR, 6.738; P = .0002; age 40-49 years: OR, 2.949; P = .0166). Patients 40-49 years of age were more likely to have received anti-EGFR therapy (OR, 2.633; P = .0016). Despite differences in care patterns, age did not predict overall survival. CONCLUSION: Despite patients with EO-CRC receiving more intensive treatments, survival was similar to the older counterpart. However, EO-CRC had clinical and molecular features associated with worse prognoses. Improved biologic understanding is needed to optimize clinical management of EO-CRC. The cost-benefit ratio of exposing patients with EO-CRC to more intensive treatments has to be carefully evaluated.

Efficacy of Retreatment with Oxaliplatin-Based Regimens in Metastatic Colorectal Cancer Patients: The RETROX-CRC Retrospective Study

“…The main clinicopathological features are summarized in Supplementary Table S1 . A total of 56.3% patients were men; the median age at diagnosis of the entire cohort was 56.91 [23.98, 79.08] and 30.3% were early-onset CRC (EO-CRC) diagnosed at an age younger than 50 [ 26 ], which was possibly “enriched” because of the attitudes in performing multiple therapeutic lines in young individuals [ 27 ]. Most of the patients were diagnosed in the stage IV disease, left-sided, or rectal primary tumor, and had their primary tumors resected.…”

Prognostic nomograms for predicting overall survival and cancer-specific survival of patients with very early onset colorectal cancer: a population‑based analysis

“…Third, detailed therapeutic information such as surgical procedures and chemotherapy regimens is lacking for the nomogram, which greatly affected survival outcomes. Recent studies are discussing the role of more intensive chemotherapy regimens such as triplets in young CRC patients [ 38 , 39 ]. Finally, due to the retrospective nature of this study, which may cause possible selection bias.…”

Age-related disparity of survival outcomes and treatment-related adverse events in patients with metastatic colorectal cancer

“…Lieu and colleagues observed younger and older ages were associated with worse survival in patients with mCRC [29]. However, all recent studies showed at least comparable [26-28, 30, 31] if not better prognosis [44] in patients with EO-mCRC. To the best of our knowledge, the present study is the first analysis of individual patients data from clinical trials and a more contemporary real-world cohort that demonstrated worse survival outcomes in patients with EO-mCRC.…”

“…Previous studies suggested an increased incidence of some specific toxicities such as nausea/vomiting in early-onset mCRC (EO-mCRC), but the data was largely limited in the adjuvant setting and findings across studies were not always in agreement [24-28]. Similarly, some studies reported a poorer survival in patients with advanced EO-CRC [24, 25, 29], whereas others observed a similar survival outcome between early-onset and average-onset patients with mCRC [26-28, 30, 31]. These discrepancies might be due to selection bias and/or the inclusion of older patients (age>65) in the average-onset group for comparison.…”