Early-Onset Colorectal Cancer in Younger Patients with a More Advanced Stage and Worse Postoperative Results: A Retrospective Review

Avellaneda, Nicolás; Lasa, Juan S.; Veracierto, Federico; Hernández, Agustín; Santillán, Mateo; Sendra, Pablo; Ricardo, Oddi; Carrie, Augusto

doi:10.4274/tjcd.galenos.2021.2021-3-1

Cited by 4 publications

(13 citation statements)

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Section: Resultsmentioning

confidence: 99%

“…Of the 12 859 unique articles retrieved, 699 full texts were reviewed, and 81 studies were included (Figure 1 and Table). There were 76 cross-sectional studies, 4 case-control studies, and 1 cohort study . Studies were performed in Africa (5 studies), Asia or the Middle East (26 studies), Europe (19 studies), North America (23 studies), South America (5 studies), and Oceania (2 studies) .…”

Section: Resultsmentioning

confidence: 99%

“…There were 76 cross-sectional studies, 4 case-control studies, and 1 cohort study . Studies were performed in Africa (5 studies), Asia or the Middle East (26 studies), Europe (19 studies), North America (23 studies), South America (5 studies), and Oceania (2 studies) . There were 67 studies deemed to have low risk of bias, 10 studies with moderate risk of bias, and 4 studies with high risk of bias, based on JBI checklists.…”

Section: Resultsmentioning

confidence: 99%

“…Studies were performed in Africa (5 studies), Asia or the Middle East (26 studies), Europe (19 studies), North America (23 studies), South America (5 studies), and Oceania (2 studies) . There were 67 studies deemed to have low risk of bias, 10 studies with moderate risk of bias, and 4 studies with high risk of bias, based on JBI checklists. Notable sources of bias included using patient-reported or inadequately defined measures of signs or symptoms and time to diagnosis (eTable 2 in Supplement 1).…”

Section: Resultsmentioning

confidence: 99%

“…There were 76 cross-sectional studies, 12, 13, 18, 27-35, 37-43, 45, 46, 48-92, 94, 96-104 4 case-control studies, 44,47,93,95 and 1 cohort study. 36 Studies were performed in Africa (5 studies), 31,41,54,65,84 Asia or the Middle East (26 studies), 18, 35, 37, 42, 48, 49, 51-53, 56, 62, 66, 67, 71, 77, 78, 80, 82, 85, 96, 99-104 Europe (19 studies), 28,29,40,43,45,46,50,55,57,58,60,63,64,72,73,75,87,91,93 North America (23 studies), 12, 27, 32-34, 36, 39, 44, 47, 59, 61, 68-70, 74, 81, 86, 88, 92, 94, 95, 97, 98 South America (5 studies), 30,38,83,89,90 and Oceania (2 studies). 76,79 There were 67 studies 12, 13, 27, 28, 30, 32-34, 36, 38-40, 44, 45, 47, 48, 51-77, 79, 81, 83, 84, 86-102, 104 deemed to have low risk of bias, 10 studies 18,29,31,35,37,46...…”

Section: Search Strategy and Study Characteristicsmentioning

confidence: 99%

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

Demb,

Kolb,

Dounel

et al. 2024

JAMA Netw Open

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ImportanceEarly-onset colorectal cancer (EOCRC), defined as a diagnosis at younger than age 50 years, is increasing, and so-called red flag signs and symptoms among these individuals are often missed, leading to diagnostic delays. Improved recognition of presenting signs and symptoms associated with EOCRC could facilitate more timely diagnosis and impact clinical outcomes.ObjectiveTo report the frequency of presenting red flag signs and symptoms among individuals with EOCRC, to examine their association with EOCRC risk, and to measure variation in time to diagnosis from sign or symptom presentation.Data SourcesPubMed/MEDLINE, Embase, CINAHL, and Web of Science were searched from database inception through May 2023.Study SelectionStudies that reported on sign and symptom presentation or time from sign and symptom presentation to diagnosis for patients younger than age 50 years diagnosed with nonhereditary CRC were included.Data Extraction and SynthesisData extraction and quality assessment were performed independently in duplicate for all included studies using Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines. Joanna Briggs Institute Critical Appraisal tools were used to measure risk of bias. Data on frequency of signs and symptoms were pooled using a random-effects model.Main Outcomes and MeasuresOutcomes of interest were pooled proportions of signs and symptoms in patients with EOCRC, estimates for association of signs and symptoms with EOCRC risk, and time from sign or symptom presentation to EOCRC diagnosis.ResultsOf the 12 859 unique articles initially retrieved, 81 studies with 24 908 126 patients younger than 50 years were included. The most common presenting signs and symptoms, reported by 78 included studies, were hematochezia (pooled prevalence, 45% [95% CI, 40%-50%]), abdominal pain (pooled prevalence, 40% [95% CI, 35%-45%]), and altered bowel habits (pooled prevalence, 27% [95% CI, 22%-33%]). Hematochezia (estimate range, 5.2-54.0), abdominal pain (estimate range, 1.3-6.0), and anemia (estimate range, 2.1-10.8) were associated with higher EOCRC likelihood. Time from signs and symptoms presentation to EOCRC diagnosis was a mean (range) of 6.4 (1.8-13.7) months (23 studies) and a median (range) of 4 (2.0-8.7) months (16 studies).Conclusions and RelevanceIn this systematic review and meta-analysis of patients with EOCRC, nearly half of individuals presented with hematochezia and abdominal pain and one-quarter with altered bowel habits. Hematochezia was associated with at least 5-fold increased EOCRC risk. Delays in diagnosis of 4 to 6 months were common. These findings highlight the need to identify concerning EOCRC signs and symptoms and complete timely diagnostic workup, particularly for individuals without an alternative diagnosis or sign or symptom resolution.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Search Strategy and Study Characteristicsmentioning

confidence: 99%

See 3 more Smart Citations

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

Demb,

Kolb,

Dounel

et al. 2024

JAMA Netw Open

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Surgical and survival outcomes of early‐onset colorectal cancer patients: a single‐centre descriptive Australian study

Garrett,

Steffens,

Solomon

et al. 2024

ANZ Journal of Surgery

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BackgroundEarly‐onset colorectal cancer (EOCRC) incidence is increasing in Australia. However, no Australian studies have reported on EOCRC patients' surgical management and survival patterns.MethodsA retrospective study of 111 EOCRC patients treated at the Royal Prince Alfred Hospital (RPAH), Sydney, Australia between January 2013 and December 2021 was performed. RPAH is a quaternary referral centre for pelvic exenteration (PE) and cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC).ResultsMost patients had left‐sided tumours (76.58%) and stage IV disease at the time of presentation (37.85%). 27.93% of patients underwent either CRS/HIPEC and PE and 72.07% of patients underwent other colorectal resections of which the most common was low anterior resection (19.82%). A stoma was fashioned in 50.54% of patients. Complications occurred in 54.95% of patients of which most were Clavien‐Dindo grade II (47.54%). Absolute 1‐, 3‐ and 5‐year time intervals were 93.69%, 87.39% and 85.48%. Disease‐free and overall survival were poorer in stage IV patients who had PE, followed by CRS/HIPEC then other colorectal resections (P < 0.001 and P = 0.003).ConclusionsStoma formation, PE and CRS/HIPEC and minor postoperative complications were common in our EOCRC cohort. Despite this, the 5‐year absolute survival rate was acceptable. Thus, an aggressive surgical approach in EOCRC patients at a quaternary referral centre may be feasible at the cost of greater postoperative morbidity. This information is imperative in the surgical consent and preoperative counselling of EOCRC patients and highlights the need for further research to assess the postoperative functional outcomes and quality of life of EOCRC patients.

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The health‐related quality of life of early‐onset colorectal cancer patients: an Australian cross‐sectional study

Garrett,

Koh,

Solomon

et al. 2024

Colorectal Disease

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AimEarly‐onset colorectal cancer (EOCRC) patients are more likely to have advanced disease and undergo more aggressive treatment modalities. However, current literature investigating the health‐related quality of life (HRQoL) of EOCRC patients is scarce. This study aimed to determine the HRQoL of an Australian cohort of EOCRC patients including a subset who underwent pelvic exenteration (PE) or cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).MethodA cross‐sectional study of EOCRC patients treated at the Royal Prince Alfred Hospital, Sydney Australia was performed. Patients were divided into groups based on the time interval from their index operation: ≤2 years and >2 years. HRQoL was evaluated using the SF‐36v2 questionnaire.ResultsA total of 50 patients were included. For patients ≤2 years from surgery, the median physical component summary (PCS) and mental health component summary (MCS) scores were 53.3 (36.4–58.9) and 47.3 (37.5–55.7). In the >2 years group, the median PCS and MCS scores were 50.6 (43.3–57.7) and 50.2 (39.04–56.2), respectively. Stage I (vs. stage II) disease and emergency (vs. elective) surgery conferred poorer PCS scores in patients ≤2 years from surgery. No other variables impacted PCS or MCS scores in EOCRC patients in either group.ConclusionsHRQoL of EOCRC patients was equivocal to the Australian population. Having an earlier stage of diagnosis and emergency index operation was associated with poorer levels of physical functioning in patients ≤2 years from surgery. However, because of the limitations of this study, these findings require validation in future large‐scale prospective research.

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Early-Onset Colorectal Cancer in Younger Patients with a More Advanced Stage and Worse Postoperative Results: A Retrospective Review

Cited by 4 publications

References 0 publications

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

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

Surgical and survival outcomes of early‐onset colorectal cancer patients: a single‐centre descriptive Australian study

The health‐related quality of life of early‐onset colorectal cancer patients: an Australian cross‐sectional study

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