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.
Highlights
Colorectal cancer (CRC) is the third most common cancer diagnosis worldwide [1]
The excluded patients had received their treatment in other United Kingdom (UK) centers or overseas and their treatment outcomes were not available for extraction
In the United States of America (USA) it is predicted that based on current trends, in 2030, the incidence rates for colon and rectal cancers will increase by 90.0% and 124.2%, respectively, for patients aged 20 to 34 years and by 27.7%
Summary
Colorectal cancer (CRC) is the third most common cancer diagnosis worldwide [1]. It is traditionally considered a disease of older adults, in the United Kingdom (UK) fecal occult blood CRC screening is typically reserved for people over the age of 60. CRC screening is limited to patients older than 50 years in the United States of America (USA) [2]. Onset colorectal cancer (EOCRC) is defined as diagnosis of CRC in patients younger than 50 years old. Epidemiological studies across the globe, including in Europe, Canada, USA, Australia, China, India, Japan, and Brazil, report a similar rise in incidence of CRC in young adults over the last
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