The Characterization and Outcomes of Colorectal Malignancy in Patients ≤40 Years of Age: A Single-Center Experience

Abstract

Background Implementation of screening modalities has led to a decreased incidence of colorectal malignancies. Unfortunately, overall incidence has remained unchanged as cases have increased in patients below the suggested screening age. Therefore, we evaluated characteristics and oncological outcomes of malignancies in patients ≤40 years of age. Methods Single-center retrospective analysis of prospectively collected data of malignancies in patients ≤40 years evaluated in our institution between 2010 and 2016. Basic descriptors for demographic, clinical, histologic, and genetic data were collected. Disease-free survival (DFS) and 5-year overall survival (OS) were compared for patients between 30-40 years and <30 years. Results Fifty-six patients ≤40 years were identified, 44 of whom (96.5%) had adenocarcinomas. Most common malignancy location was the rectum (64.3%). Despite aggressive tumor characteristics such as moderate/poor differentiation (88.6%), lymphovascular invasion (26.8%), perineural invasion (21.4%), and advanced tumor stage T3/T4 (60.7%), OS rate was 94.6%. Both age groups had similar oncologic characteristics. There was a trend toward worse OS (2/11 and 1/45, P = .06) but not for DFS (7/11 and 15/43, P = .18) in patients <30 years of age compared to 30-40 years. There were no differences in OS (3/44 vs 0/88, P = .44) or DFS (17/42 vs 3/8, P = .80) between sporadic vs non-sporadic malignancies, respectively. Conclusions Patients ≤40 years of age with malignancy have advanced tumor stages and aggressive tumor characteristics at diagnosis. Although there is higher OS risk for patients <30 compared to those aged 30-40 years, no differences were found for DFS between these two groups.

Early versus Late Onset Colorectal Cancer: Pathological Distinctions and Optimal Screening Age Determination in a Decade-Long Study

“…They also showed a higher ratio of dMMR, along with a greater incidence of perineural and vascular invasion. These observations were similar to the ndings of Gabriel et al [21][22][23], who reported that EOCRC becomes more aggressive as the tumor stage advances. These changes might be attributed to advanced tumor staging that commonly occurs in EOCRC patients.…”

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

“…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 .…”

“…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) .…”

“…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.…”

“…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).…”