Characteristics of Early-Onset vs Late-Onset Colorectal Cancer
Date
2021
Authors
Zaborowski, A.M.
Abdile, A.
Adamina, M.
Aigner, F.
d’Allens, L.
Allmer, C.
Álvarez, A.
Anula, R.
Andric, M.
Atallah, S.
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Advisors
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Journal article
Citation
JAMA Surgery, 2021; 156(9):865-874
Statement of Responsibility
REACCT Collaborative: Alexandra M. Zaborowski ... Hidde Maarten Kroon ... Tarik Sammour ... et al.
Conference Name
Abstract
IMPORTANCE The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer. OBSERVATIONS Within the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include aWesternized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts. CONCLUSIONS AND RELEVANCE The clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes.
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Published online June 30, 2021. Corrected on August 11, 2021.
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© 2021 American Medical Association. All rights reserved.