96P - Early-onset colorectal cancer prognosis, conflict resolution, review of literature and meta-analysis

Background

Early-onset colorectal cancer (EOCRC) is defined as colorectal cancer diagnosed in individuals younger than 50 years old. There is a concept that EOCRC is associated with a worse survival, while the data on literature is conflicting. Evaluation of the available data is highly needed to reach an evidence-based conclusion.

Methods

A systematic literature search was performed using Scopus (2015-2020), CENTRAL PubMed (2015-2020) for studies assessed prognosis of EOCRC in comparison with LOCRC using the relative 5-year survival (OS) as a surrogate for prognosis. Extracted information included: study identification, number of EOCRC and LOCRC patients, AJCC stage, and overall 5-year survival. Keywords and Mesh words used: prognosis, outcome, survival, young, early-onset, age of onset, colorectal cancer, rectal cancer, colon cancer. Statistical analysis was done using MedCalc Statistical Software for the meta-analysis.

Results

Meta-analysis for a total of 428554 LOCRC and 670030 EOCRC patients of the included 9 studies showed no statistically significant difference in male ( P= 0.19 ) or female ( P= 0.20 ) as regards the incidence EOCRC when compared to LOCRC. Younger adults were1.2 more likely to present with left-sided and rectal cancer ( OR;1.20, 95% CI, 0.18 to 7.86, P= 0.84 ) than older patients, while the right colon cancer was less presented by 79% in EOCRC patients (OR; 0.79, 95%CI, 0.05 to 11.13, P= 0.86). Stage I disease was statistically significant less diagnosed in EOROC than LOCRC patients ( P< 0.001, 95%CI, 0.31 to 0.70 ), while there were no statistically significant differences for stages II, III, and IV, ( P= 0.27, 95%CI, 0.03 to 2.58), ( P= 0.84, 95%CI, 0.03 to 4.57) and ( P= 0.70, 95%CI, 0.10 to 4.62 ) respectively. There was no difference in the 5 year OS between EOCRC and LOCRC patients ( P= 0.62, 95%CI, -0.004 to 0.002). Subgroup analysis based on the stage showed a better survival in EOCRC patients in all stage groups; ( P= 0.03, 95%CI,1.34 to 21.19) for stage I, (P, 0.001, 95%CI, 2.38 to 3.64) for stage II, (P< 0.001, 95%CI, 2.20 to 4.80) for stage III, and (P= 0.009, 95%CI, 1.62 to 28.79) for stage IV.

Conclusions

EOCRC patients had a similar 5-year OS when compared to LOCRC while had a better 5-year OS when corrected for the disease stage.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Quality Control Unit, Faculty of Medicine, Assiut University.

Disclosure

All authors have declared no conflicts of interest.