Survival outcomes and prognostic factors in early-onset colorectal cancer

Abstract

Introduction: Despite the increasing incidence of early-onset colorectal cancer (EOCRC) worldwide, data from Vietnam remain limited, especially concerning long-term treatment outcomes. This study aimed to evaluate the clinical characteristics, long-term outcomes, and prognostic factors in patients with EOCRC.

Patients and Methods: This retrospective study included patients diagnosed with colorectal cancer (CRC) before the age of 50. Clinical and paraclinical data were collected, and patients were followed up to evaluate long-term treatment outcomes. The primary endpoints were overall survival and the identification of prognostic factors.

Results: EOCRC cases were evenly distributed between genders and were predominantly localized on the left side of the colon. The median interval from symptom onset to diagnosis was 2 months. A total of 96% of patients reported no first-degree family history of colorectal cancer. Abdominal pain was a characteristic symptom of right-sided tumors, whereas lower gastrointestinal bleeding was more frequently observed in left-sided tumors. The mean overall survival (OS) was 50.0 months (95% CI, 46.7–53.4), and the mean disease-free survival (DFS) was 49.9 months (95% CI, 46.1–53.8). The 5-year survival rate was 68.4%. Poor prognostic factors associated with reduced OS included a serum CEA level > 4.7 ng/mL at diagnosis (HR: 3.1; 95% CI, 1.5–6.4; p = 0.003), poorly differentiated tumors (HR: 3.2; 95% CI, 1.4–7.3; p = 0.005), and advanced stage at diagnosis (HR: 16.8; 95% CI, 2.3–123.6; p = 0.006).

Conclusions: The majority of EOCRC cases occurred sporadically, with a short interval from symptom onset to diagnosis. Tumors were more commonly located in the left side of the colon. Additionally, left-sided tumors were associated with lower gastrointestinal bleeding as a prominent symptom and were linked to higher serum CEA levels compared to right-sided tumors. In contrast, right-sided tumors more commonly presented with abdominal pain and showed a higher proportion of mucinous or signet ring cell histology. The mean overall survival (OS) was 50.0 months. Serum CEA level at diagnosis, tumor differentiation grade, and disease stage were identified as key prognostic factors.

Keywords: Long-term outcomes, prognostic factor, early-onset colorectal cancer

References

1. Bray, F., et al., Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 2024. 74(3): p. 229-263.
2. Ren, B., et al., Survival outcome and prognostic factors for early-onset and late-onset metastatic colorectal cancer: a population based study from SEER database. Scientific Reports, 2024. 14(1): p. 4377.
3. Bui, C.V., Survey on the prevalence and incidence of rectal cancer at Oncology Hospital from January 2006 to December 2007. Ho Chi Minh city Journal of Medicine, 2010. 14(4): p. 284-288.
4. ÑT, T., Analysis of the morphology of colorectal cancer. Ho Chi Minh city Journal of Medicine, 2007. 11(3): p. 86-88.
5. Quach, T.D. and T.O. Nguyen, Clinical, endoscopic and pathogical characteristics of early-onset colorectal cancer in Vietnamese. Asian Pac J Cancer Prev, 2012. 13(5): p. 1767-1770.
6. Ruiz-Grajales, Á.E., et al., Clinical and pathological differences between early- and late-onset colorectal cancer and determinants of one-year all-cause mortality among advanced-stage patients: a retrospective cohort study in Medellín, Colombia. Cancer Treatment and Research Communications, 2024. 39: p. 100797.
7. Collaborative, R., Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review. JAMA Surgery, 2021. 156(9): p. 865-874.
8. Amin, M.B., et al., AJCC Cancer Staging Manual. 8 ed. 2017: Springer.
9. Hoang, D.K., et al., Colorectal cancer in young adults: clinical characteristics and outcomes. Vietnam Medical Journal, 2023. 525(4): p. 353-358.
10. Liao, C.K., et al., Differences in characteristics and outcomes between early-onset colorectal cancer and late-onset colorectal cancers. Eur J Surg Oncol, 2024. 50(12): p. 108687.
11. Dinh Phuong Tran, T., et al., Clinical, Paraclinical And Histopathological Characteristics Of Colorectal Cancer Patients At The Department Of Gastroenterology – Cho Ray Hospital. Ho Chi Minh city Journal of Medicine, 2025. 28(1): p. 19-29.
12. Tran, T.N.Q.Q., et al., Histopathological characteristics of colorectal cancer at 108 Military Central Hospital from 2017 to 2020. Journal of 108 – Clinical Medicine and Phamarcy, 2024. 19.
13. Gandini, A., et al., Early-Onset colorectal Cancer: From the laboratory to the clinic. Cancer Treatment Reviews, 2024. 130.
14. Manh Duc, H., et al., Results Of Radical Surgery In Treatment Of Colorectal Cancer Under 35 Years Old. Vietnam Medical Journal, 2022. 519(1).
15. Pham, H.C., et al., Colorectal Cancer In Young Adults. Journal of Oncology Vietnam, 2019.
16. Quach, D.T. and O.T. Nguyen, Clinical, endoscopic and pathogical characteristics of early-onset colorectal cancer in Vietnamese. Asian Pac J Cancer Prev, 2012. 13(5): p. 1767-70.
17. Saraiva, M.R., I. Rosa, and I. Claro, Early-onset colorectal cancer: A review of current knowledge. World J Gastroenterol, 2023. 29(8): p. 1289-1303.
18. Thi Mai, N. and V. Hong Thang, Treatment Outcomes Of Colon Cancer In Young Patients At K Hospital In Period 2016-2020. Vietnam Medical Journal, 2022. 508(2).
19. AlZaabi, A., et al., Early onset colorectal cancer: Challenges across the cancer care continuum. Annals of Medicine and Surgery, 2022. 82.
20. Lakemeyer, L., et al., Diagnostic and Prognostic Value of CEA and CA19-9 in Colorectal Cancer. Diseases, 2021. 9(1).
21. Konishi, T., et al., Association of Preoperative and Postoperative Serum Carcinoembryonic Antigen and Colon Cancer Outcome. JAMA Oncol, 2018. 4(3): p. 309-315.
22. Pemaj, X., et al., P-234 Association between tumor differentiation grade and TNM staging in colorectal cancer. Annals of Oncology, 2022. 33: p. S332.