Clinical Characteristics, Prognostic Factors And Survival Of Early-Onset Colorectal Cancer (Eocrc) In A Spanish Cohort

Over the last decades the incidence of EOCRC (< 50 years old) has dramatically increased. Thus, scientific interest in this field has risen. The aim of this study was to show differences in clinical characteristics, co-morbidities, prognostic factors, and survival among EOCRC compared to the rest of colorectal cancer (CRC) patients in a Spanish hospital. We conducted a retrospective analysis of 554 patients with metastatic colorectal cancer (mCRC) in a tumor registry from 2015 to 2021, analyzing the clinical and molecular characteristics, as well as progression-free survival (PFS) and overall survival (OS) of EOCRC patients versus the rest of CRC patients. We applied the exact test of Fisher in order to identify differences between categoric variables, and Mann-Whitney test to detect differences between quantitative variables. PFS and OS were compared using a long-rank test, and the estimate of hazard ratio (HR) between studied groups was calculated by means of Cox proportional hazards model. We found 554 mCRC patients of which 68 (12.25 %) were EOCRC patients. Several characteristics were significantly more frequent in patients with EOCRC: BMI < 18.5 (n = 16, OR 1.9, P = 0.046), primary tumor site at transverse colon (n = 9, OR 2.61, p = 0.03) and ECOG 0 (n = 32, OR 2.21, p = 0.003). Moreover, mean values of LDH at diagnosis were significantly higher in EOCRC patients (359 U/L vs 280 U/L, p = 0.015). EOCRC patients received a significantly higher number of lines of chemotherapy (2.94 vs 2.38, p = 0.027) and underwent more surgeries (2.42 vs 1.24, p < 0,001) than patients with > 50 years. Significant differences in tumor mutational status (BRAF, KRAS, NRAS, MSI, PI3K and HER2) between groups were not found. PFS was longer in EOCRC patients (median, 16.2 vs 11.3 months; HR for progress 0.77; 95 % confidence interval (CI) 0.56 to 0.99; p = 0.043), as well as overall survival (median 121.5 vs 58.1; HR for death 0.58; 95 % CI, 0.39 to 0.88; p = 0.011). Our study showed that EOCRC patients had more frequently BMI < 18.5, primary tumor located at transverse colon and ECOG 0, along with a statistically significant higher PFS in first line and higher OS than the rest of CRC patients.