Outcomes of Patients with Early Onset Colorectal Cancer Treated in a UK Specialist Cancer Center

Abstract

The incidence of early onset colorectal cancer (EOCRC) is rapidly increasing, but there remains paucity of outcome data for young CRC patients. We reviewed the characteristics and outcomes of 241 adults, age <50, who were diagnosed with EOCRC between January 2009 and December 2014. Median age was 42, 56% were male, and 7% had hereditary etiology. Seventy percent had left-sided primaries. At diagnosis, 11%, 50%, and 39% had stage II, III, and IV CRC. Of the patients with stage II and III CRC who underwent curative surgery, 60% and 88% had adjuvant chemotherapy, with 5-year relapse free survival of 82% and 74% respectively. Of the 123 patients with metastatic (m) EOCRC, 93%, 63%, 33%, and 12% had 1st, 2nd, 3rd, and 4th line systemic anticancer therapy (SACT) respectively. For first line SACT, 99% had doublet chemotherapy, with bevacizumab or an anti-EGFR antibody in 57%. Median overall survival (mOS) of mEOCRC patients was 20.1 months (95% C.I: 15.9–23.2). Younger age and signet cells were associated with shorter mOS, whereas more lines of SACT and curative metastasectomy with longer mOS. Metastatic EOCRC patients had poorer outcomes than expected, despite optimal multimodality treatment. This suggests an aggressive disease biology that warrants further research and therapy development.

Updates on age to start and stop colorectal cancer screening: recommendations from the U.S. Multi-Society Task Force on Colorectal Cancer

“…25 EAO-CRC also appears to have more aggressive histopathology than LAO-CRC. Overall, mucinous and signet ring histologies were seen in 10.0% to 14.5% [26][27][28][29] and 2.0% to 13.0% 26,27,29 of EAO-CRCs, respectively, with up to 27.9% of cancers being poorly differentiated or undifferentiated. 24 Data from the National Cancer Database showed that EAO-CRC was modestly, but significantly, more likely to have a mucinous and/or signet-ring histology compared with LAO-CRCs (12.6% vs 10.8%, P < .01) and poor or no differentiation (20.4% vs 18%, P < .01).…”

“…Abdelsattar et al 25 reported a relative risk of 1.37 (95% CI, 1.33-1.41) and 1.58 (95% CI, 1.53-1.63) for younger patients to present with regional or distant metastasis, respectively, compared with older patients. Chen et al 24 found that the difference in stage at presentation between EAO-CRC Presenting with symptoms, % 86.4 23 -95.6 79,80 33.9-79.0 80,81 Incidental or screen detected, % 1.6-5.2 24,80 3.4-14.6 24,80 Duration of symptoms, days 243 24 154 24 Time to diagnosis, days 152-217 24,82 29.5-87 24,82 Family history of CRC, % 13.8-33.5 24,81,83 8.3-19.3 24,81,83 Location, % Right-sided colon 16.2-35.2 23,24,26,27,35,[79][80][81]83 28.5-51.5 24,35,81,83 Left-sided colon 29.1-53.0 23,24,26,27,35,79 28.9-48.5 24,35,80,83 Rectal 25.4-49.1 23,24,…”

Non-anaemic iron deficiency should be investigated with the same priority as iron deficiency anaemia in fast track colorectal clinics—retrospective cohort study

“…What this paper is adding: Latest BSG [2011] guidelines suggest presence of iron deficiency alone is enough to warrant bowel investigation (2). It is necessary to clear the concept of iron deficiency without anaemia.…”

Innate immune genes distinguish the immune microenvironment of early onset colorectal cancer

“…This rise in early onset CRC does not correlate with patterns of obesity or heavy alcohol use (9). Young patients with CRC are more likely to present with regional or metastatic disease, high grade, mucinous, and signet ring tumors (3,7,8,(10)(11)(12)(13)(14)(15)(16). Early onset is more commonly located in the rectum and left colon compared to late onset CRC (7,(14)(15)(16).…”

“…Young patients with CRC are more likely to present with regional or metastatic disease, high grade, mucinous, and signet ring tumors (3,7,8,(10)(11)(12)(13)(14)(15)(16). Early onset is more commonly located in the rectum and left colon compared to late onset CRC (7,(14)(15)(16). Patients with early onset CRC appear to have similar or improved stage-specific and overall survival (7,10,11,13,16).…”