Abstract 494P
Background
Although colorectal cancer (CRC) prevalence increases with age, in the last two decades a considerable rise in the incidence of early-onset (EO) disease has been observed, defined as that which occurs in patients (pts) younger than 50 years old. With most cases being sporadic, this clearly represents a serious public health concern.
Methods
We performed a retrospective study assessing the characteristics of an EO CRC cohort pts and correlating them with older pts in the same period. Demographic and clinicopathological data were collected prospectively and its impact in disease outcome was determined. Survival analysis was estimated by Cox proportional-hazards model.
Results
From January 2010 to January 2020, 210 EO pts were identified, representing 9.6% of a total cohort of 2193 CRC pts in that period. Median age at EO diagnosis was 44.1 years old (yo) (range 16-50) with 60.9% of pts between 45 and 50 yo; 126 pts (60%) were male, and most presented with distal colon (48, 22.8%) and rectum (120, 57.1%) tumours. Distribution by stages was I: 16 (7.6%), II: 46 (21.9%), III: 93 (44.2%) and IV: 55 (26.2%). In advanced setting, 13 (37.3%) had RAS mutations, 3 (6.8%) BRAF V600E and microsatellite instability was detected in 10 pts (4.8%). When compared with older pts cohort, we found significantly higher proportion of EO pts diagnosed in stage IV (26.2% vs 12.6%), with a non-significant better median overall survival (OS) for EO pts in this subgroup [38.3 vs 35.3 months; HR 0.92 (95% CI 0.59-1.43), p=0.698]. Nevertheless, EO pts have a worse OS at 60-months [75% vs 82%; HR 1.37 (95% CI 1-1.87), p=0.061]. In 152 pts (72.3%) genetic counselling was conducted, with 15 (9.8%) having a hereditary cancer-predisposing syndrome, mainly Lynch syndrome and familial adenomatous polyposis.
Conclusions
Our results resemble already known epidemiological and clinical data from other EO CRC series and highlight some challenges in this setting, such as the great amount of pts diagnosed in advanced stage and lower overall survival than their older counterparts. They also suggest that an improvement strategy could be to advance the start of screening programmes in average-risk population.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
J.C.C. Ruffinelli: Non-Financial Interests, Personal, Invited Speaker: Roche Farma; Non-Financial Interests, Personal, Invited Speaker: Pierre Fabre; Non-Financial Interests, Personal, Other: Bristol Myers Squibb; Non-Financial Interests, Personal, Other: Novartis; Non-Financial Interests, Personal, Other: Merck. J.M. Brunet Vidal: Non-Financial Interests, Personal, Advisory Board: AstraZeneca. C. Santos Vivas: Non-Financial Interests, Personal, Invited Speaker: Amgen; Non-Financial Interests, Personal, Invited Speaker: Pierre Fabre; Non-Financial Interests, Personal, Invited Speaker: Sanofi. All other authors have declared no conflicts of interest.