Clinicopathological patterns and survival outcomes of colorectal cancer among young adults in Malaysia: an institutional cohort study

Abstract

Introduction: This study aimed to investigate the clinicopathological patterns and survival outcomes of young-onset colorectal cancer (CRC) in Malaysia. Methods: The study consisted of 206 patients with young-onset CRC (age < 50 years at diagnosis) and 1,921 patients with late-onset CRC (age ≥ 50 years at diagnosis) diagnosed during 2002–2016. The clinicopathological characteristics of patients with young-onset CRC were compared with those of patients with late-onset CRC during 2009–2013. Kaplan-Meier survival analysis was performed to determine the overall survival (OS) and disease-specific survival (DSS) in these patients. Results: The overall proportion of young-onset CRC was 10.7%. Mean age for young-onset CRC was 39.5 ± 7.4 years, with male-to-female ratio of 1.2:1.0. There were more Malay patients with young-onset CRC than late-onset CRC (44.0% vs. 19.9%, p = 0.004). Most CRC were diagnosed at advanced stage in both groups. However, young-onset CRC showed more aggressive tumour characteristics, such as poorer differentiation and mucinous subtype. Despite such differences, OS and DSS in both groups were similar (five-year OS for young-onset CRC vs. late-onset CRC: 44.2% vs. 49.0%, p = 0.40; five-year DSS for young-onset CRC vs. late-onset CRC: 48.8% vs. 57.6%, p = 0.53; mean survival of young-onset CRC vs. late-onset CRC: 4.9 years vs. 5.4 years, p = 0.15). Advanced stage at diagnosis and treatment modality were independent prognostic factors. Conclusion: The unique ethnic and histological differences between patients with young- and late-onset CRC suggest that young-onset CRC may represent a distinct entity. However, despite such differences, prognosis between both groups were equivalent.

Comparison of the short‐ and long‐term prognosis of early‐onset colorectal cancer compared with later‐onset colorectal cancer: A systematic review and meta‐analysis

“…Several studies have shown poor survival outcomes due to a higher proportion of progressive tumours, 46 , 47 whereas others have reported a better prognosis than later‐onset patients. 40 , 42 , 48 However, previous studies have certain limitations, such as inconsistent definitions of EOCRC or LOCRC, 49 , 50 , 51 studies only on patients with progressive tumours, 52 , 53 and insufficient study inclusion for prognostic analysis (fewer than 100 cases), 17 , 54 which do not allow for the exposure of actual prognostic differences between the two age groups. Our study found no differences in 5‐year CSS, consistent with the results of several large‐scale retrospective studies in recent years, 20 , 55 and similar results were obtained for metastatic CRC.…”

Red Flag Signs and Symptoms for Patients With Early-Onset Colorectal Cancer

“…There were 78 studies 12,13,18,[94][95][96][97][98][99][100][101][102][103][104][105][106][107][108] that reported on 17 signs and symptoms at presentation, based on claims or medical records (66 studies), 12, 13, 27, 28, 30, 32-34, 38-40, 42-45, 47, 48, 51-77, 79, 81, 83, 84, 86-92, 94-104 patient report (6 studies), 18,29,37,46,80,82 or other (7 studies). 31,35,41,49,50,78,85 (Figure 2; eFigure 1 in Supplement 1).…”

The Prediction of Survival Outcome and Prognosis Factor in Association with Comorbidity Status in Patients with Colorectal Cancer: A Research-Based Study

“…The Duke’s stage or TNM staging, number of lymph nodes involved, distant metastases, pre and postoperative carcinoembryonic antigen (CEA) level, tumour grade and location are regarded as prognostic markers with utmost prognostic importance that predict the survival of individuals with colorectal cancer [ 7 , 8 ]. In colorectal cancer, the best prognosis estimate is based on the anatomic extent of illness as established by the pathological inspection of the resected specimen [ 9 ]. However, precise prognostic factor identification for colorectal cancer CRC still poses a challenge; thus, further research is required to understand the predictive relevance of clinicopathological factors in CRC, particularly for Malaysian records.…”