Stage‐specific characterization of “early‐onset colorectal cancer”: Localized and synchronous metastatic disease

Abstract Early‐onset colorectal cancer (EOCRC) is an alarming entity worldwide. Yet, stage‐specific characteristics and prognosis in localized and synchronous metastatic EOCRC are not well‐defined. Two cohorts of CRC patients (localized and synchronous metastatic) were evaluated, defining EOCRC as the diagnosis <50 years old. Five hundred sixty‐eight patients were included ( n = 432 localized, 14.4% [ n = 62] EOCRC and n = 136 synchronous metastatic, 20.6% [ n = 28] EOCRC). 93.5% of localized and 96.5% of synchronous metastatic EOCRC patients were symptomatic at diagnosis. Among localized patients, female gender (58.1% vs. 40%, p = .008), perineural invasion (41.9% vs. 24.9%, p = .005), folinic acid, 5‐fluorouracil, and oxaliplatin chemotherapy (45.2% vs. 25.2%, p = .003), and perioperative chemotherapy cycles (9.21 [± 3.10] vs. 7.98 [± 2.92], p = .006) were higher in EOCRC compared with ≥50‐year. Median recurrence‐free survival (RFS) and overall survival were not reached in either group ( p = .234 and p = .831). Only RAS mutant status was associated with RFS (Hazard ratio: 7.09 [95% confidence interval (CI): 1.87–26.76], p < .001) in EOCRC. Among synchronous metastatic patients, urgent surgery (32.1% vs. 11.1%, p = .014) and local treatments (39.3% vs. 20.4%, p = .037) were more frequent in EOCRC. Median progression‐free survival and overall survival in the EOCRC and ≥50 years were 8.07 months (95% CI: 5.03–12.97) vs. 10.03 months (95% CI, 8.40–13.10) ( p = .450) and 18.57 months (95% CI, 13.33–43.03) vs. 19.83 months (95% CI, 16.07–27.30) ( p = .833), respectively. Synchronous metastatic EOCRC more frequently underwent urgent surgery (32.1% vs. 8%, p = .008) and had RAS mutation (43.5% vs. 16.7%, p = .032) than localized EOCRC. This study suggests that localized and synchronous metastatic EOCRC patients may have different characteristics than average onset, without survival differences. Implementation of stage‐specific characteristics into daily practice is necessary for decision‐making processes in these young patients.