Colorectal Cancer in North-Eastern Iran: a retrospective, comparative study of early-onset and late-onset cases based on data from the Iranian hereditary colorectal cancer registry

Abstract

Background The incidence rate of colorectal cancer (CRC) is increasing among patients below 50 years of age. The reason for this is unclear, but could have to do with the fact that indicative variables, such as tumour location, gender preference and genetic preponderance have not been followed up in a consistent mann er. The current study was primarily conducted to improve the hereditary CRC screening programme by assessing the demographic and clinicopathological characteristics of early-onset CRC compared to late-onset CRC in northeast Iran. Methods This retrospective study, carried out over a three-year follow-up period (2014–2017), included 562 consecutive CRCs diagnosed in three Mashhad city hospital laboratories in north-eastern Iran. We applied comparative analysis of pathological and hereditary features together with information on the presence of mismatch repair (MMR) gene deficiency with respect to recovery versus mortality. Patients with mutations resulting in absence of the MMR gene MLH1 protein product and normal BRAF status were considered to be at high risk of Lynch syndrome (LS). Analyses using R studio software were performed on early-onset CRC (n = 222) and late-onset CRC (n = 340), corresponding to patients ≤50 years of age and patients > 50 years. Results From an age-of-onset point of view, the distribution between the genders differed with females showing a higher proportion of early-onset CRC than men (56% vs. 44%), while the late-onset CRC disparity was less pronounced (48% vs. 52%). The mean age of all participants was 55.6 ± 14.8 years, with 40.3 ± 7.3 years for early-onset CRC and 65.1 ± 9.3 years for late-onset CRC. With respect to anatomical tumour location (distal, rectal and proximal), the frequencies were 61, 28 and 11%, respectively, but the variation did not reach statistical significance. However, there was a dramatic difference with regard to the history of CRC in second-degree relatives between two age categories, with much higher numbers of family-related CRCs in the early-onset group. Expression of the MLH1 and PMS2 genes were significantly different between recovered and deceased, while this finding was not observed with regard to the MSH6 and the MSH2 genes. Mortality was significantly higher in those at high risk of LS. Conclusion The variation of demographic, pathological and genetic characteristics between early-onset and late-onset CRC emphasizes the need for a well-defined algorithm to identify high-risk patients.

The Clinicopathological Characteristics of Young-Onset Versus Adult-Onset Colorectal Cancer: A Tertiary Hospital-Based Study

“…Previous studies had compared annual incidence, family history of CRC, clinicopathological features, and the overall survival rate in young-onset CRC (YOCRC) < 50 years old and adult-onset CRC (AOCRC) ≥ 50 years old ( 10 – 12 ). AOCRC, also called late-onset CRC, was reported to have prominence on the proximal colon with a declining rate due to the implemented screening programmes among these adult patients ( 13 , 14 ).…”

PTEN hamartoma tumour syndrome: case report based on data from the Iranian hereditary colorectal cancer registry and literature review

“…The Iranian Hereditary Colorectal Cancer Registry (IHCCR) is a programme specifically designed to identify individuals at high risk of hereditary colorectal cancer or polyposis in Iran [20][21][22][23]. IHCCR confirms these cases through whole-exome sequencing (WES), a comprehensive genetic test that sequences all of the protein-coding gene regions [24].…”

The Analysis between Clinicopathological Aspect of Early-Onset vs Late-Onset Colorectal Cancer and Mortality Rate

“…1,11 Mortality rate as a postoperative outcome is a patient's postoperative outcome based on the condition of life or death. 12 Nowadays, there have only been studies abroad that have compared the clinicopathological characteristics of early-onset and late-onset colorectal cancer (EOCRC vs LOCRC) [13][14][15] , but there is a lack of data that analyse the correlation between these clinicopathological aspects and post-operative outcomes such as mortality rates, especially in developing countries like Indonesia. Therefore, this study aimed to analyse the comparison of clinicopathological features between early-onset and late-onset CRC as well as the correlation between CRC onset and mortality rate in Dr. Hasan Sadikin Hospital, Bandung as local data that can be used to support global data.…”