Sarah J. Wood, MD, Leigh-Ann J. Webb, MD, MBA, Elan Freedy, MBA
University of Virginia, Charlottesville, VA
Introduction: In the United States, colorectal cancer (CRC) is the most common malignancy of the gastrointestinal tract and third most common cancer. While incidence rates of colorectal cancer in the older population continues to decline, incidence rates in adults aged less than 50 years have been on the rise since the 1990s. The increase of CRC in this younger population is almost solely confined to the Caucasian race. In the younger population, key symptoms often go unrecognized and misdiagnoses often precede the suspicion for malignancy. Our large, retrospective study aimed to better understand the outcomes and survival horizons of young patients with CRC.
Methods: A population dataset for CRC cases from 2003-2015 was acquired from the NCI SEER database. Data extracted from SEER includes all CRC cancer diagnoses from 2003-2015 for patients aged less than 50 years old. There were 48,506 cases in total.The data was cleaned and merged, and subsequently analyzed by various modalities including Kaplan-Meier Survival Estimators, Cox Proportional Hazard Ratio, and Logistic Regression.
Results: From 2003-2015, 75% of all individuals diagnosed with early-onset CRC were of Caucasian race. The majority of patients at time of diagnosis were found to have high tumor burden, no metastatic disease, and moderate (grade 3) differentiation. Approximately half of the initial diagnoses were T3. Despite large tumor burden, over 70% of young adult patients were M0 and 46.8% were N0 at time of diagnosis. Collectively, 70% of tumors were either poorly or moderately differentiated. Kaplan-Meier analysis showed overall 10-year survival of those with early onset CRC a mere 57%. Unsurprisingly, hazards ratio showed that the presence and degree of metastasis, tumor burden (stage T4), poor differentiation, and elevated CEA have the highest impact on decreasing survival.
Discussion: Our retrospective study showed that most patients diagnosed with early onset CRC had high tumor burden, no metastatic disease, and moderate to poor differentiation. Despite that 70% of patients were M0 at time of diagnosis, 10-year survival is only 57%. The escalating rates of CRC in the younger population is a serious public health concern that highlights the need for appropriate, timely follow-up of symptoms. Recently, both the ACS and ACP, have amended CRC screening guidelines to those of average risk to start at age 45, which will enable earlier detection and likely better survival outcomes for those with early-onset CRC.
Citation: Sarah J. Wood, MD, Leigh-Ann J. Webb, MD, MBA, Elan Freedy, MBA. P1146 - EARLY-ONSET COLORECTAL CANCER TRENDS AND SURVIVAL. Program No. P1146. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.