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Prognostic impact of clinico-pathologic parameters in early- and average-onset curatively resected colorectal cancer
Background
Nearly a third of patients with curatively resected colorectal cancer experience recurrence. However, prognostic data do not discern sporadic early onset colorectal cancer (EO-CC) from average onset colorectal cancer (AO-CC). The aim of this study was to estimate the incidence and relevance of routinely assessed clinico-pathologic prognostic parameters across age cohorts.
Methods
We compared a comprehensive array of clinico-pathologic characteristics in patients with non-metastatic EO-CC (age 60) treated in a tertiary cancer center between 2000-2020, using Fisher’s Exact Test. Logistic regressions and Kaplan Meier curves were performed to determine correlations with patient outcomes.
Results
A total of 216 patients with surgically resected non-metastatic primary colon adenocarcinoma met criteria for inclusion in the study (EO-CC: n=73, mean age 42 years, 44.4% male gender; AO-CC: n=143, mean age 71 years, 52.5% male gender). Compared with AO-CC, the EO-CC group was more likely to have family history of cancer (52.4% vs 28.4%, p=0.002), present with tumor obstruction (58.7% vs 24.8%, p 20 nodes removed, 71.4% vs 40.4%, p < 0.001; adjuvant chemotherapy stage 2: 54.3% vs 22.9%, p=0.003, stage 3: 95.2% vs 75%, p=0.08). Overall survival was longer in EO-CC (87.3% vs 78.4% log-rank p=0.001) as expected, however cancer-specific outcomes were significantly inferior for EO-CC with a shorter relapse-free survival (76% vs 86%, log-rank p=0.002) and 1.6 shorter time to recurrence during the designated study period. In both groups, 10% of patients died of cancer. In the EO-CC group, all deaths were cancer-related, most due to active disease and one of capecitabine toxicity, while in AO-CC, 47% of all deaths were cancer related. Recurrence and survival were equally associated with prognostic factors across age cohorts.
Conclusions
The prognostic impact of clinico-pathologic parameters were confirmed among EO-CC and AO-CC patients. However, EO-CC had significantly inferior cancer-specific outcomes despite exhibiting identical histopathological features and receiving more aggressive surgical and oncological treatment. Further research should aim to elucidate the causes and manifestations of a potentially more aggressive disease biology.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
