Early-Onset Colorectal Cancer in Patients under 50 Years of Age: Demographics, Disease Characteristics, and Survival

McClelland, Paul H.; Liu, Tianming; Özüner, Gökhan

doi:10.1016/j.clcc.2021.11.003

Cited by 24 publications

(28 citation statements)

References 37 publications

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“…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. 52 However, patients with LOCRC had a worse 5-year OS, associated with risk factors for death associated with increasing age, including ischaemic heart disease (coronary heart disease), stroke, chronic obstructive pulmonary disease, metabolic syndrome, and kidney disease.…”

Section: Discussionsupporting

confidence: 93%

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

Jin

et al. 2023

Health Science Reports

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Background and Aims: The annual incidence of early-onset colorectal cancer (EOCRC) is increasing at an alarming rate. The prognosis of EOCRC remains controversial, and whether the early onset is a risk factor for colorectal cancer remains unclear.Methods: We searched four electronic bibliographic databases from database inception to April 25, 2022 for studies that included both early-and later-onset patients and performed a prognostic analysis. Random-effects models were used to summarize the prognostic information extracted by the investigators, including overall survival (OS), cancer-special survival (CSS), and disease-free survival (DFS).Network meta-analysis (NMA) was used to compare patients' long-term prognoses in different age subgroups.Results: After 694 reports were screened, 13 studies were included in the final analysis, with a total of 448,781 CRC cases. In the meta-analysis of the 5-year OS, EOCRC had a better prognosis compared to LOCRC (hazard ratio [HR] 0.87, 95% confidence interval [CI], 0.74-0.99; relative risk [RR] 0.83, 95% CI, 0.78-0.89). No difference in prognosis was found between the two groups in terms of 5-year CSS (RR 0.99, 95% CI, 0.93-1.05), 5-year DFS (RR 0.90, 95% CI, 0.74-1.09), and shortterm OS. In the NMA, patients aged <30 years had the worst outcome (surface under the cumulative ranking curve [SUCRA], 15.8%) in 5-year OS; consistent results were observed in the analysis of 5-year CSS (<30 years, SUCRA 4.5%), but the difference was not statistically significant. Conclusion:Although patients with early-onset CRC had better OS than those with later-onset CRC, there was no difference in the CSS. Meanwhile, the trend for survival was worse in younger patients, especially in those ages 18-29 years. Thus, more attention should be paid to early diagnosis and treatment of EOCRC.

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Section: Discussionsupporting

confidence: 93%

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

Jin

et al. 2023

Health Science Reports

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“…Age is often found to be an independent prognostic factor of OS in population based analysis of rectal cancer, but there is a lot of controversy [23,24]. In contrast to their old counterparts, EORC patients had a poorer long-term and short-term survival [25]. But in the present study, age was found to be an independent risk factor of OS with HR > 1 both in the crude and matched cohorts (both P < 0.001).…”

Section: Discussioncontrasting

confidence: 61%

Impact of age on the prognosis and decision-making of adjuvant treatment for resectable rectal cancer- a population based analysis

Wang

Lai

Zhong

et al. 2022

Preprint

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Background Different age groups exhibit disparate patterns of epidemiology, clinicopathology, treatment response, and prognosis in relation to rectal cancer (RC), but little is known about the interactions between age and adjuvant treatment (AT) for resectable RC. Methods The Surveillance, Epidemiology, and End Results database (SEER) was used to identify patients who had received surgery but not neoadjuvant treatment for rectal adenocarcinoma between 2010 and 2015. Restricted cubic spline (RCS) was used to identify the optimal cut-off value of age for overall survival (OS) and cancer-specific survival (CSS), and then further analysis was performed using Kaplan-Meier (KM) curves and propensity score matching (PSM) stratified by different age groups, pathological stage (pT1 − 2N0, pT3 − 4N0, pT1 − 4N+), and AT modalities including chemotherapy (CT), radiotherapy (RT), and CT + RT. Results 7951 patients were eligible for this study, and age was found to be an independent risk factor of OS and CSS after adjusted other risk factors (all P < 0.001). 50 years old was identified as the optimal cut-off value for OS and CSS using RCS, and patients aged < 50 years old (early-onset rectal cancer, EORC) have a significantly better prognosis than those aged ≥ 50 years old (late-onset rectal cancer, LORC) before and after PSM (both P < 0.001). Among the EORC patients, only subgroup of pT1 − 4N + was found to be benefited from AT before and after PSM (both P < 0.05), and further analysis showed that this population was only benefited from adjuvant CT in terms of OS (P < 0.05). Among LORC patients, subgroups of pT3 − 4N0 and pT1 − 4N + were both found to be benefited from AT (both P < 0.001). Further analysis showed that adjuvant CT and CT + RT could both significantly improve the OS of these two subgroups (all P < 0.05), but adjuvant RT alone was only found to benefit those staged at pT1 − 4N+ (P < 0.05). Conclusions The optimal age threshold for RC patients undergoing direct surgery was 50 years old. Patients with EORC staging at pT1-4N + should receive adjuvant CT + RT. Patients with LORC staging at pT3-4N0 and pT1-4N + should receive adjuvant CT + RT or CT. In addition, adjuvant RT alone could also be an option for selected LORC patients. However, this conclusion deserves further validation by prospective cohorts.

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“…1 Currently, early-onset colorectal neoplasms, which develop before 50 years of age, are a hot research topic as their incidence increases in Western and Eastern countries. [2][3][4][5][6][7][8][9][10][11] Several studies have identified the risk and preventive factors for early-onset colorectal neoplasms in Western countries. Obesity, Western diet, smoking, and alcohol and meat consumption are the predominant risk factors for early-onset colorectal neoplasms.…”

Section: Introductionmentioning

confidence: 99%

“…Colorectal cancer (CRC) is the leading cause of cancer‐related deaths worldwide and is the second and third most commonly diagnosed cancer in women and men, respectively 1 . Currently, early‐onset colorectal neoplasms, which develop before 50 years of age, are a hot research topic as their incidence increases in Western and Eastern countries 2–11 …”

Section: Introductionmentioning

confidence: 99%

Risk and preventive factors of early‐onset colorectal neoplasms: endoscopic and histological database analysis

Arai

Aoki

Hayakawa

et al. 2022

J of Gastro and Hepatol

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Background and Aim:The incidence of early-onset colorectal neoplasms has been increasing in both Western and Eastern countries. However, the risks and preventive factors for these neoplasms in Eastern countries remain unclear. Methods: The data of 5580 patients who underwent colonoscopy between 2016 and 2021 were retrospectively evaluated. The primary outcome was advanced colorectal neoplasm (ACRN), defined as advanced adenomas (adenoma ≥10 mm, or with high-grade dysplasia or villous component) or adenocarcinoma. The clinical factors associated with ACRNs were determined for each age category (≤50 and >50 years), and the differences between the two categories were assessed. Odds ratios adjusted for age and sex were calculated. Results: Among 1001 patients (age ≤50 years), ACRN was found in 94 (9.4%). In this younger category, male sex (adjusted odds ratio [aOR]:2.34, 95% confidence interval [CI]:1.51-3.63) and a family history of colorectal cancer (aOR:2.14, 95% CI:1.17-3.89) were significantly associated with higher odds of developing ACRNs. ACRNs were detected in 726 (15.9%) of 4579 patients (age >50 years). In the older age category, smoking (aOR:1.32, 95% CI:1.08-1.63) was significantly associated with a higher risk of ACRNs. Exercise of >3.5 metabolic equivalent of task (METs) (aOR,0.80; 95% CI:0.67-0.96) was significantly associated with a lower risk of ACRNs. Conclusion:The development of early-onset ACRNs was primarily associated with congenital factors, whereas that of late-onset ACRNs was associated with acquired ones. Colonoscopy is recommended for young male patients, particularly for those with a family history of colorectal cancer.

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Early-Onset Colorectal Cancer in Patients under 50 Years of Age: Demographics, Disease Characteristics, and Survival

Cited by 24 publications

References 37 publications

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

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

Impact of age on the prognosis and decision-making of adjuvant treatment for resectable rectal cancer- a population based analysis

Risk and preventive factors of early‐onset colorectal neoplasms: endoscopic and histological database analysis

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