Early- vs. late-onset colon cancer: clinicopathological insights and survival outcomes in an East Asian cohort.

PURPOSE: Colorectal cancer (CRC) is the third most prevalent cancer worldwide, showing an increasing early-onset CRC in patients, which is defined as diagnoses made before the age of 50. Studies conflict on early-onset CRC prognosis versus late-onset CRC with varying survival outcomes. This study explores the age-related survival differences in colon cancer by comparing early- and late-onset groups.

METHODS

We performed a retrospective cohort study at a tertiary referral hospital (2010-2018), including 3459 patients with colon cancer (3076 late-onset, 383 early-onset). The clinicopathological features of early- and late-onset colon cancer were compared, and cancer-specific survival was evaluated using the Kaplan-Meier analysis with log-rank tests. The multivariate Cox regression identified independent prognostic factors.

RESULTS

Early-onset colon cancer showed female predominance, better Eastern Cooperative Oncology Group performance, more left-sided tumors, and advanced stages. On the contrary, late-onset patients had worse cancer-specific survival (hazard ratio 1.506, 95% confidence interval 1.147-1.977, p = 0.003), particularly in stages II/III, with tumor perforation, signet ring cells, or no perineural invasion.

CONCLUSION

In conclusion, despite early-onset colon cancer exhibiting more aggressive features, it is associated with better survival compared with late-onset cases. Further studies are required to validate these findings.