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Comparative Study
. 2025 Oct 9;40(1):212.
doi: 10.1007/s00384-025-05007-4.

Early- vs. late-onset colon cancer: clinicopathological insights and survival outcomes in an East Asian cohort

Chun-Chi Lin  1   2 , Che-Yuan Chang  1 , Yu-Zu Lin  1 , Hou-Hsuan Cheng  1 , Sheng-Chieh Huang  1   2 , Hung-Hsin Lin  1   2 , Yuan-Tzu Lan  1   2 , Huann-Sheng Wang  1   2 , Shih-Ching Chang  1   2 , Shung-Haur Yang  2   3 , Jeng-Kai Jiang  1   2 , Wei-Shone Chen  2   4 , Hao-Wei Teng #  2   5 , Yi-Wen Yang #  6
Affiliations
Comparative Study

Early- vs. late-onset colon cancer: clinicopathological insights and survival outcomes in an East Asian cohort

Chun-Chi Lin et al. Int J Colorectal Dis. .

Abstract

Purpose: Colorectal cancer (CRC) is the third most prevalent cancer worldwide, showing an increasing early-onset CRC in patients, which is defined as diagnoses made before the age of 50. Studies conflict on early-onset CRC prognosis versus late-onset CRC with varying survival outcomes. This study explores the age-related survival differences in colon cancer by comparing early- and late-onset groups.

Methods: We performed a retrospective cohort study at a tertiary referral hospital (2010-2018), including 3459 patients with colon cancer (3076 late-onset, 383 early-onset). The clinicopathological features of early- and late-onset colon cancer were compared, and cancer-specific survival was evaluated using the Kaplan-Meier analysis with log-rank tests. The multivariate Cox regression identified independent prognostic factors.

Results: Early-onset colon cancer showed female predominance, better Eastern Cooperative Oncology Group performance, more left-sided tumors, and advanced stages. On the contrary, late-onset patients had worse cancer-specific survival (hazard ratio 1.506, 95% confidence interval 1.147-1.977, p = 0.003), particularly in stages II/III, with tumor perforation, signet ring cells, or no perineural invasion.

Conclusion: In conclusion, despite early-onset colon cancer exhibiting more aggressive features, it is associated with better survival compared with late-onset cases. Further studies are required to validate these findings.

Keywords: Age-related survival outcomes; Cancer-specific survival; Colon cancer; Early-onset colon cancer; Prognostic factors.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This retrospective study was conducted using the population-based data from the Taipei Veterans General Hospital in Taiwan in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the Institutional Review Board and Ethics Committee of the Taipei Veterans General Hospital (2024–05-009CC). Given the retrospective study design, the requirement for written informed consent was waived by the IRB. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study population selection. *Among the patients who did not receive surgery for their primary tumor, 98 patients were a clinically stage IV patient. A total of 11 patients had early-onset stage IV colon cancer, whereas 87 had late-onset colon cancer
Fig. 2
Fig. 2
Cancer-specific survival across age categories in the study population. a Cancer-specific survival by age group in stage I colon cancer; b Cancer-specific survival by age group in stage II colon cancer; c Cancer-specific survival by age group in stage III colon cancer; d Cancer-specific survival by age group in stage IV colon cancer
Fig. 2
Fig. 2
Cancer-specific survival across age categories in the study population. a Cancer-specific survival by age group in stage I colon cancer; b Cancer-specific survival by age group in stage II colon cancer; c Cancer-specific survival by age group in stage III colon cancer; d Cancer-specific survival by age group in stage IV colon cancer
Fig. 3
Fig. 3
Comparative cancer-specific survival of late- vs. early-onset colon cancer across diverse subgroups
See this image and copyright information in PMC

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