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Multicenter Study
. 2022 Dec 1;13(12):e00543.
doi: 10.14309/ctg.0000000000000543.

Young Patients With Colorectal Cancer Have Higher Early Mortality but Better Long-Term Survival

Shuyuan Wang  1 , Zhen Yuan  1 , Kemin Ni  1   2 , Yixiang Zhan  1   2 , Xuanzhu Zhao  2   3 , Zhaoce Liu  1   2 , Yanfei Liu  4 , Ben Yi  4 , Sizhen Lai  3 , Xin Yin  1 , Xingyu Zhou  1 , Yuqi Wang  1 , Hangyu Ping  1 , Ran Xin  1 , Wenhong Wang  5 , Hongzhou Li  6 , Yuanshun Zhao  6 , Youkui Han  7 , Weifeng Gao  2 , Xinlei Jin  3 , Guihua Wang  8 , Zili Zhang  9 , Guoxun Li  2   10   11 , Qinghuai Zhang  2   10   11 , Xipeng Zhang  2   10   11 , Hong Ma  2 , Chunze Zhang  2   10   11
Affiliations
Multicenter Study

Young Patients With Colorectal Cancer Have Higher Early Mortality but Better Long-Term Survival

Shuyuan Wang et al. Clin Transl Gastroenterol. .

Abstract

Introduction: To define the prognosis of colorectal cancer (CRC) in young patients and to compare their postoperative treatment with that of older patients.

Methods: This multicenter study enrolled 5,457 patients with primary CRC who underwent surgical resection. The overall survival (OS), clinicopathologic characteristics, and postoperative treatment of 253 young patients aged 18-44 years and 5,204 older patients aged 44-80 years were analyzed.

Results: The OS rate was 77.1% for young and 74.2% for older patients (P = 0.348). Landmark analysis showed a significant difference in survival between young and older patients, with 63.8% of deaths among young patients being within 25 months of surgery compared with 42.4% among older patients (P = 0.002). Among those who survived more than 25 months, young patients had significantly better survival than older patients (P = 0.009). Multivariable analysis of young patients revealed that the tumor location, perineural invasion, and stage were associated with poor survival within 25 months; after this period, stage was the only prognostic marker. Young patients were more likely to receive chemotherapy, particularly multiagent regimens. For young patients, no significant difference in OS was found based on the chemotherapy regimen, regardless of disease stage (II, III, or IV, all P > 0.05). In addition, unlike in older patients, no difference in OS was found in young patients regardless of the drug regimen administered (all P > 0.05).

Discussion: Young-onset CRC may have a unique disease biology that warrants further research and therapy development.

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Conflict of interest statement

Guarantor of the article: Chunze Zhang, PhD.

Specific author contributions: C.Z., S.W., Z.Y., K.N. and Y.Z.: conceptualization. X.Z., Z.Z. and Y.L.: methodology. B.Y., S.L., X.Y., X.Z., Y.W., R.X., W.W., H.L., Y.Z., H.M., X.Z. and H.P.: data collection. Y.H., W.G., X.J. G.W., Z.Z., G.L. and Q.Z.: data analysis. C.Z., S.W., Z.Y. and K.N.: writing—original draft preparation. C.Z., S.W., Z.Y., K.N., Y.Z., Y.H., W.G., X.J. and Q.Z.: writing—review and editing. S.W. and Z.Y.: supervision. All authors have read and agreed to the published version of the manuscript.

Financial support: This work was supported by grants from National Key R&D Program of China, Grant Number: 2017YFC1700606 and 2017YFC1700604; Key R&D Projects in the Tianjin Science and Technology Pillar Program, Grant Number: 19YFZCSY00420; Natural Science Foundation of Tianjin, Grant Number: 21JCZDJC00060 and 21JCYBJC00180; Tianjin Key Medical Discipline (Specialty) Construction Project, Grant Number: TJYXZDXK-044A.

Potential competing interests: None to report.

Figures

Figure 1.
Figure 1.
(a) Landmark analysis of OS with a breakpoint at 25 months after surgery for young patients aged 18–44 years vs older patients aged 44–80 years. (b) Naïve Kaplan-Meier estimates of OS for young vs older patients. (c) OS rate stratified by age and tumor stage. (d) Proportion of deaths within 25 months of surgery to total deaths stratified by age and tumor stage. OS, overall survival.
Figure 2.
Figure 2.
Kaplan-Meier estimates of overall survival stratified by the use of postoperative chemotherapy. Young patients aged 18–44 years with stage II (a), stage III (b), and stage IV CRC (c). Older patients aged 44–80 years with stage II (d), stage III (e), and stage IV CRC (f). (g) Chemotherapy regimens in young and old patients with stage II and III CRC. CRC, colorectal cancer.
See this image and copyright information in PMC

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