Clinicopathologic characteristics of early onset colon-rectal cancer: A single center experience.

Abstract

538 Background: Colorectal cancer (CRC) is the second leading cause of cancer deaths in the U.S. Early recognition of CRC in young patients (pts) is a challenge, and clinicopathologic features at the time of presentation are not well described. The aim of this study was to compare clinico-pathological characteristics and survival between early onset CRC (Age <50) and late onset CRC (Age ≥50). Methods: We reviewed the records of all patients diagnosed with CRC at our institution from 1999 to 2013. Total of 3,066 pts were studied. Demographics, tumor characteristics, and survival rate were analyzed. Patients with polyposis syndromes or genetic predisposition for CRC were excluded. Kaplan-Meier and Cox regression were used for the statistical analysis. Results: Of 3,066 pts, 425 pts (14%) under the age of 50 were identified (28-49). Hispanics (13% vs 8%, p<0.01) and African Americans (7% vs. 4%, p<0.009) were more prevalent in the early onset subgroup (EO) when compared to the late onset subgroup (LO). Pts were more likely to have sigmoidal and rectal tumors in the EO 187 (44%) than in the LO 799 (30%), (p<0.0001). Mucinous and signet cell tumors were more frequent histological subtypes in EO pts (12% vs. 7%, p<0.0003; 5% vs. 3%, p<0.04, respectively). At diagnosis, EO pts were more likely to have well-differentiated tumors and advanced disease than LO pts (59% vs. 34%, p<0.0001; 61% vs. 44%, p<0.0001, respectively). Median survival was 133 months in EO (95% CI: 113-160) and 87 months in LO (95% CI: 77-89) (p<0.01). African American descent (OR: 1.6 p<0.009), Hispanic ethnicity (OR: 1.9 p<0.001) right-colon tumors (OR: 1.65 p<0.003) and positive margins (OR: 1.98 p<0.001) were independent and significant predictors of survival by multivariate analysis in the EO subgroup. Colon cancer was the primary cause of death in 24% of EO vs. 11% LO (p<0.0001). Conclusions: In our cohort, EO subgroup was more likely to have advanced disease with predominance of well-differentiated and left-colon tumors. EO subgroup has better overall survival and that could be explained by the lack of comorbidities in this group. Further research should aim to elucidate the basis of these differences, as this could potentially impact screening and management.