Regional patterns of early-onset colorectal cancer from the GEOCODE (Global Early-Onset COlorectal Cancer DatabasE)-European consortium: retrospective cohort study

Abstract

Background: The incidence of early-onset colorectal cancer is increasing, but in Europe this growth shows a heterogeneous pattern in different countries and regions.

Methods: Patients from six countries who participated in the Global Early-Onset COlorectal Cancer DatabasE (GEOCODE)-Europe group were included. The inclusion criteria were patients with colorectal adenocarcinoma diagnosed between 18 and 49 years of age, between January 2010 and December 2017, with at least 3 years of follow-up. Patients with inherited colorectal cancer syndromes were excluded.

Results: A total of 851 patients were included with almost equal sex distribution, most were diagnosed at age 39 years or older and 42% of patients were overweight or obese. Diagnoses were predominantly at later stages (62.5% stage III-IV) and tumours were predominantly located in the distal colon (76.9% left colon and rectum). Comparative analysis between countries demonstrated that the UK had a younger age at diagnosis and the Italian cohort had a higher prevalence of being overweight or obese. Patients from Luxembourg had more advanced stage diagnoses and those from The Netherlands had more polyps. Patients from the UK had a greater family history of colorectal cancer. Comparison of Mediterranean versus non-Mediterranean countries showed significant differences in the age at diagnosis and body mass index. The prevalence of early-onset colorectal cancer over the age of 40 years in Mediterranean versus non-Mediterranean countries was 71.4% versus 62.1% (P = 0.002), and early-onset colorectal cancer was diagnosed at a more advanced stage in Mediterranean countries versus non-Mediterranean countries (65.3% versus 54.7%; P = 0.033). Family history of colorectal cancer in a first-degree relative was more common in non-Mediterranean versus Mediterranean countries (19.1% versus 11.4%; P < 0.001).

Conclusion: This study highlights significant geographical disparities in the clinical, pathological and familial features of early-onset colorectal cancer across European countries.

Fig. 1

Distribution of the participating centres in the corresponding countries in GEOCODE-Europe 1. Humanitas Clinical and Research Centre, Rozzano Milan (Italy). 2. Centre Hospitalier de Luxembourg (Luxembourg). 3. Leiden University Medical Centre, Leiden, The Netherlands. 4. Bielanski Hospital, Warsaw, Poland. 5. Orlowski Hospital, Warsaw, Poland. 6. Hospital Clínic, Barcelona, Spain. 7. Vall d´Hebron University Hospital, Barcelona, Spain. 8. 12 de Octubre University Hospital, Madrid, Spain. 9. Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK. 10. St. Mark’s Hospital, Harrow, UK. 11. West Middlesex University Hospital, London, UK. GEOCODE, Global Early-Onset COlorectal Cancer DatabasE.

Fig. 2

Characteristics according to the different variables of each country a Age of onset. b Body mass index (BMI). c Stage of diagnosis. d Mucinous component. e Synchronous polyps. f Familial cancer history. CRC, colorectal cancer.

Fig. 3

Characteristics according to the different variables between a Mediterranean and b non-Mediterranean countries CRC, colorectal cancer; FDR, first-degree relative; EOCRC, early-onset colorectal cancer; early CRC stage, tumour stage at diagnosis I or II.