The Clinicopathological Characteristics of Young-Onset Versus Adult-Onset Colorectal Cancer: A Tertiary Hospital-Based Study

Abstract

Background: The prevalence of colorectal cancer (CRC) among young individuals is rising worldwide, especially in Malaysia. Investigations are currently employed to distinguish the features of young-onset CRC (YOCRC) from adult-onset CRC (AOCRC). This study aimed to compare the characteristics of patients with YOCRC and AOCRC diagnosed at Hospital Universiti Sains Malaysia (HUSM).

Methods: This was a retrospective study of CRC cases from January 2013 to December 2021. The details of YOCRC (< 50 years old) and AOCRC (≥ 50 years old) patients were retrieved from the laboratory system and medical records. The Pearson's chi-square test, Fisher's exact test and multiple logistic regression were used to compare the AOCRC and YOCRC cases. Statistical significance was defined at a P-value of ≤ 0.05.

Results: The AOCRC (254/319, 79.6%) was more prevalent than YOCRC (65/319, 20.4%), with a predominance of males (53.9%) and Malay sub-population (90.2%). AOCRC and YOCRC shared similarities in left-sided location, high occurrence of adenocarcinoma with moderately differentiated histology and advanced stage of diagnosis. More patients with YOCRC (23.1%) had a family history of cancer than patients with AOCRC. YOCRC also differed from AOCRC by having more specific histological subtypes, such as mucinous adenocarcinoma (15.4%) and signet ring carcinoma (6.2%). In addition, patients with YOCRC commonly presented with a low density of tumour-infiltrating lymphocytes (TILs) (60%). Multiple logistic regression showed a family history of CRC (adjusted odds ratio [AOR] = 3.75, P = 0.003) and histological type (AOR = 15.21, P < 0.001) are more likely to cause YOCRC than diabetes (AOR = 0.06, P < 0.001) and hypertension (AOR = 0.14, P < 0.001) comorbidities, which are associated with AOCRC.

Conclusion: Our descriptive study presented the epidemiological and histopathological characteristics of AOCRC and YOCRC in HUSM, providing current information on distinguishing features between the groups.

Keywords: Malaysia; clinicopathological; colorectal cancer; early-onset; late-onset.

Figure 1

CRC occurrence among YOCRC and AOCRC patients yearly

Figure 2

Number of 319 CRC cases with gender per age group among YOCRC and AOCRC

Figure 3

Histological subtypes of CRC with (A) Classical adenocarcinoma - malignant glandular cells arranged in a glandular pattern (arrow) within the desmoplastic stroma. The tumour cells are pleomorphic, having oval to round elongated vesicular nuclei, with some exhibiting prominent large nuclei and abundant eosinophilic cytoplasm. (B) Mucinous adenocarcinoma - malignant tumour cells arranged in clusters and nest patterns with moderate nuclear pleomorphism suspended in pools of extracellular mucin (arrow). (C) Signet ring cells carcinoma - tumour cells arranged in clusters and singly exhibited poorly differentiated signet ring cells with eccentrically placed nuclei (arrow) due to abundant intracytoplasmic mucin. (D) Neuroendocrine carcinoma - malignant glandular cells arranged in a glandular and true resetting pattern

Figure 4

Differences in TILs expression between AOCRC and YOCRC. (A) AOCRC with malignant glands arranged in an irregular glandular pattern exhibiting moderately differentiated adenocarcinoma having high intratumoural lymphocytic infiltrates. (B) YOCRC with moderately differentiated adenocarcinoma comprising malignant glands arranged in a complex glandular, cribriform pattern with low intratumoural lymphocytic infiltrates