Highlights
- •A total of 240,772 SEER patients with colorectal cancer (2004-2015) were analyzed
- •About 14.6% of patients were diagnosed with early-onset colorectal cancer (age 20-49)
- •By decade, patients at young and old age extremes had worse 5 year survival
- •Diagnostic stage was the most significant predictor of increased mortality risk
- •Older age, not younger age, was independently linked with increased mortality risk
Abstract
Introduction
Incidence of early-onset colorectal cancer (EO-CRC) is increasing in younger demographics.
This study analyzes disease-specific survival in individuals under 50 years of age.
Methods
Patients with colorectal malignancy were identified in the Surveillance Epidemiology
and End Results (SEER) database from 2004 to 2015. Cases were categorized into typically
screened (age 50-79 years) and non-typically screened (age 20-49 years) cohorts, as
well as by decade. Kaplan-Meier curves and Cox proportional hazard models were used
to study survival.
Results
A total of 240,772 patients with colorectal cancer were analyzed. Average annual percent
change in incidence was -0.24% among typically screened patients and +1.12% among
patients with EO-CRC. Patients with EO-CRC more frequently presented with distal tumors
(70.6% vs. 57.6%, P < .001) and advanced tumor stage (61.3% vs. 48.6%, P < .001). Patients aged 50 and over had comparable 5 year disease-specific survival
to younger patients (68.2% vs. 66.4%, P = .31); however, patients in the 3rd, 4th, and 8th decade of life had particularly
low survival rates (59.0% vs. 65.8% vs. 65.8%, logrank P < .001). Patients aged 20-29 years had the most increased risk of cause-specific
mortality on univariable Cox regression analysis [HR 1.43, 95% CI 1.31-1.56; P < .001], although this was not significant on multivariable analysis [HR 1.06, 95%
CI 0.97-1.15; P = .201]. Male sex, older age, advanced stage, rectal and/or cecal primary, and earlier
year of diagnosis were independently associated with increased mortality.
Conclusion
Patients with EO-CRC are diagnosed at a later stage and have lower disease-specific
survival than those in typically screened cohorts. Additional studies on tumor biology
and surveillance strategies are needed to improve outcomes in this population.
Keywords
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Article info
Publication history
Published online: November 27, 2021
Accepted:
November 22,
2021
Received in revised form:
October 5,
2021
Received:
May 12,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
