Early age of onset is an independent predictor for worse disease-free survival in sporadic rectal cancer patients. A comparative analysis of 980 consecutive patients

Foppa, Caterina; Tamburello, Sara; Maroli, Annalisa; Carvello, Michele; Poliani, Laura; Laghi, Luigi; Malesci, Alberto; Montorsi, Marco; Perea, José; Spinelli, Antonino

doi:10.1016/j.ejso.2021.10.021

Cited by 20 publications

(12 citation statements)

References 39 publications

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“…The clinicopathological features underlying molecular profiles that act as drivers of EoCRC differ from those of late-onset disease. A substantial proportion of patients with EoCRC may need to receive surgical treatment, which is associated with unfavorable outcomes [ 48 , 49 ]. Moreover, significant risk factors for EoCRC also include a family history of CRC, hyperlipidemia, and inflammatory bowel disease [ 50 , 51 ].…”

Section: Discussionmentioning

confidence: 99%

The Burden of Early-Onset Colorectal Cancer and Its Risk Factors from 1990 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019

Pei

Lyu

et al. 2022

Cancers

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Background: The incidence of early-onset colorectal cancer (CRC) diagnosed before age 50 has been increasing over the past decades. Hence, we examined the global, regional, and national burden of early-onset CRC and its risk factors from 1990 to 2019. Methods: Using data from the Global Burden of Disease (GBD) Study 2019, we reported the incidence, deaths, and disability-adjusted life-years (DALYs) attributable to the risk factors of early-onset CRC. All estimates were reported with 95% uncertainty intervals (UIs). Results: The global numbers of early-onset CRC for incidence, deaths, and DALYs in 2019 were 225,736 (95% UI, 207,658 to 246,756), 86,545 (80,162 to 93,431), and 4,259,922 (3,942,849 to 4,590,979), respectively. Despite large variations at the regional and national levels, the global incidence rate, death rate, and DALY rate increased from 1990 to 2019. Diets low in milk, diets low in calcium, and alcohol use were the leading risk factors in 2019. From 1990 to 2019, a high body mass index and high fasting plasma glucose ranked remarkably higher among males and females, while smoking and diets low in fiber ranked lower among both sexes, with a more profound change among females. Conclusions: Despite large variations in regional and national levels, the global incidence rate, death rate, and DALY rate increased during the past three decades. These findings may provide policymakers with an accurate quantification of the burden of early-onset CRC and targeted identification of those most at risk to mitigate the burden of early-onset CRC.

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Section: Discussionmentioning

confidence: 99%

The Burden of Early-Onset Colorectal Cancer and Its Risk Factors from 1990 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019

Pei

Lyu

et al. 2022

Cancers

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“…Consistently with this result, we previously found a poorer RFS in stages I–II adolescents and young adults (AYA) RC patients when compared to a matched late-onset cohort [ 11 ]. Additionally, we reported a worse RFS in stage I EORC patients when compared to the LORC counterpart [ 12 ]. Age > 65 years was identified as an independent factor associated with a lower risk for nodal metastases in T1 CRC in two recently published studies [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…According to the current literature, EOCRC are more located in the left colon and rectum, have often a mucinous and signet ring cells histology, a poorer tumor differentiation, and are more advanced at diagnosis when compared to LOCRC [ 1 , 4 ]. Comparative results about long-term survival are still discordant [ 8 , 9 , 10 , 11 , 12 ]. The lack of data and standardization of the cut-off age may explain the discrepancies and the impossibility to interpret the reported outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…A better understanding of the characteristics and etiology of EOCRC—and its differences with the late-onset counterpart—may help to promote effective prevention, early detection, and treatment strategies. A comparative study between sporadic early- and late-onset rectal cancer (RC) reporting age of onset as an independent predictor for disease progression and recurrence and worse oncologic outcomes in stage I patients was recently published by our group [ 12 ]. We here aimed to investigate whether the age of onset may impact on disease recurrence/progression in sporadic colon and rectal cancers analyzed together.…”

Section: Introductionmentioning

confidence: 99%

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Different Oncologic Outcomes in Early-Onset and Late-Onset Sporadic Colorectal Cancer: A Regression Analysis on 2073 Patients

Foppa

Maroli

Lauricella

et al. 2022

Cancers

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The incidence of colorectal cancer (CRC) is increasing in the population aged ≤ 49 (early-onset CRC-EOCRC). Recent studies highlighted the biological and clinical differences between EOCRC and late-onset CRC (LOCRC-age ≥ 50), while comparative results about long-term survival are still debated. This study aimed to investigate whether age of onset may impact on oncologic outcomes in a surgical population of sporadic CRC patients. Patients operated on for sporadic CRC from January 2010 to January 2022 were allocated to the EOCRC and LOCRC groups. The primary endpoint was the recurrence/progression-free survival (R/PFS). A total of 423 EOCRC and 1650 LOCRC was included. EOCRC had a worse R/PFS (p < 0.0001) and cancer specific survival (p < 0.0001) compared with LOCRC. At Cox regression analysis, age of onset, tumoral stage, signet ring cells, extramural/lymphovascular/perineural veins invasion, and neoadjuvant therapy were independent risk factors for R/P. The analysis by tumoral stage showed an increased incidence of recurrence in stage I EOCRC (p = 0.014), and early age of onset was an independent predictor for recurrence (p = 0.035). Early age of onset was an independent predictor for worse prognosis, this effect was stronger in stage I patients suggesting a potentially—and still unknown—more aggressive tumoral phenotype in EOCRC.

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“…A few studies have also explored increasing trends of earlier onset of other gastrointestinal malignancies, most notably colorectal cancer. 12,13 This has led to revised age-based colorectal screening recommendations in the United States (now starting at 45 y instead of 50 y). How this relates to the disproportionate increase in midgut tumors in this study is unknown.…”

Section: Discussionmentioning

confidence: 99%

A Real-World Study of the Incidence and Outcomes of Early-Onset Well-differentiated Neuroendocrine Neoplasms

Abdel‐Rahman

Ghosh

2022

American Journal of Clinical Oncology

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Objective: The objective of this study was to evaluate the incidence and outcomes of adults with early-onset (20 to 34 y) diagnosis of well-differentiated neuroendocrine neoplasms. Methods: Surveillance, Epidemiology, and End Results (SEER)-18 database was accessed, and patients with well-differentiated lung or digestive tract neuroendocrine neoplasms diagnosed 2000 to 2018 were reviewed. Annual percent changes (APCs) were calculated for the 3 disease subsites (foregut, midgut, and hindgut) stratified by age group. Kaplan-Meier survival estimates/log-rank testing were used to examine differences in overall survival between the 3 age groups. Multivariable Cox regression analyses were used to evaluate factors affecting overall and cancer-specific survivals. Results: Throughout the study period, patients with early-onset disease (20 to 34 y) have experienced the greatest APC (20 to 34 y: 9.7; 35 to 49 y: 5.4; ≥50 y: 4.1). When APCs were stratified by disease subsite, this difference in APCs appears to be driven by midgut tumors (20 to 34 y: 19.2; 35 to 49: 8.4; ≥50 y: 3.8). Using multivariable Cox regression modeling, the following variables were associated with a higher risk of all-cause death (worse overall survival): male sex (hazard ratio [HR] 1.27; 95% confidence interval [CI]: 1.22-1.31), African American race (HR vs. white race: 1.20; 95% CI: 1.15-1.26), nonhindgut primary (HR foregut vs. hindgut primary: 2.02; 95% CI: 1.91-2.13; HR midgut vs. hindgut primary: 2.09; 95% CI: 1.95-2.24), distant disease (HR vs. regional disease: 2.06; 95% CI: 1.96-2.18), no surgery to the primary (HR: 2.34; 95% CI: 2.24-2.46), and older age (HR: 5.80; 95% CI: 4.87-6.91). Conclusion: Cases of early-onset well-differentiated neuroendocrine neoplasms have disproportionately increased over the past 2 decades (compared with other age groups), and this appears to have been driven mainly by midgut tumors.

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Early age of onset is an independent predictor for worse disease-free survival in sporadic rectal cancer patients. A comparative analysis of 980 consecutive patients

Cited by 20 publications

References 39 publications

The Burden of Early-Onset Colorectal Cancer and Its Risk Factors from 1990 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019

The Burden of Early-Onset Colorectal Cancer and Its Risk Factors from 1990 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019

Different Oncologic Outcomes in Early-Onset and Late-Onset Sporadic Colorectal Cancer: A Regression Analysis on 2073 Patients

A Real-World Study of the Incidence and Outcomes of Early-Onset Well-differentiated Neuroendocrine Neoplasms

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