Comparative Analysis of Clinicopathological Profiles and Survival Outcomes of Early-Onset Versus Late-Onset Colorectal Cancer Patients

Abstract

Aims. To study the clinicopathological characteristics and survival of patients with early onset colorectal carcinoma (CRC) (i.e., patients with age of < 50 years at time of diagnosis) versus late onset CRC (i.e., patients with age of ≥ 50 years at time of diagnosis) patients. Methods. A total of 182 patients with early-onset CRC and 284 patients with late-onset CRC diagnosed during 2008–2017 were included. The demographic and clinicopathological characteristics of patients with early-onset CRC were compared with those of patients with late-onset CRC. Kaplan-Meier survival analysis and Cox regression analysis was performed to determine the patient's prognosis. Results. The early onset and late onset CRC groups represented of 39.1% and 60.9%, respectively. The late onset group were diagnosed with a higher proportion of positive Rh antigen, comorbidities and obesity (61.4%, 70.6 % and 71.2% respectively). The early onset group was diagnosed with a higher proportion of signet ring cell carcinoma (61.9%, P = 0.018) and distant metastasis (62.0%, p > 0.0001). Moreover, low expression of CEA (CEA < 5ng/ml) was more common in late onset group than early onset (73.1% vs. 26.9%; p < 0.0001). Rectal bleeding and the rectum tumor site were more common among the early onset patients (63.5 % and 60.2 respectively). However, there was no significant difference between the two groups regarding gender distribution, address, family history and histological grade. During a median of 46 months of follow-up, 44.0% of patients had died from CRC. Shorter survival rates were observed in the early onset group CRC (p < 0.0001). The late onset CRC were associated with a low recurrence rate (p < 0.0001). Based on the multivariate analysis, clinical stage and age at diagnosis are independent risk factors for both overall survival and disease-free survival. Conclusion. The clinical stage and age at diagnosis are an independent prognostic factor for patient's outcome. The early onset group of CRC patients is more advanced at the time of diagnosis, and they should be evaluated promptly and carefully.