Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2021; 13(2): 164-175
Published online Feb 27, 2021. doi: 10.4240/wjgs.v13.i2.164
Colorectal cancer of the young displays distinct features of aggressive tumor biology: A single-center cohort study
Matteo Mueller, Marcel André Schneider, Barla Deplazes, Daniela Cabalzar-Wondberg, Andreas Rickenbacher, Matthias Turina
Matteo Mueller, Marcel André Schneider, Barla Deplazes, Daniela Cabalzar-Wondberg, Andreas Rickenbacher, Matthias Turina, Department of Surgery and Transplantation, University Hospital Zurich, Zurich 8091, Switzerland
Author contributions: Mueller M, Rickenbacher A and Turina M designed the research study; Mueller M, Schneider MA and Deplazes B performed the research; Mueller M, Schneider M, Cabalzar-Wondberg D, Rickenbacher A and Turina M analyzed the data and wrote the manuscript; all authors have read and approve the final manuscript. Rickenbacher A and Turina M contributed equally as senior authors to this work.
Institutional review board statement: The study was approved by the local Ethics Committee of the Canton of Zurich (KEK-ZH-Nr. 2019-00208).
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at matthias.turina@usz.ch.
STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was prepared and revised according to the STROBE Statement checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Matthias Turina, MD, PhD, Professor, Department of Surgery and Transplantation, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland. matthias.turina@usz.ch
Received: November 24, 2020
Peer-review started: November 24, 2020
First decision: December 20, 2020
Revised: January 2, 2021
Accepted: January 21, 2021
Article in press: January 21, 2021
Published online: February 27, 2021
ARTICLE HIGHLIGHTS
Research background

Over the last decade studies reported a rising incidence of colorectal cancer (CRC) in the younger population below the age of recommended screening thresholds. Alongside a higher incidence of young-onset CRC, there is more and more evidence of advanced tumors among younger patients. Reasons for increased tumor aggressiveness are the subject of active debate. Besides genetic risk factors, environmental factors may also play a decisive role.

Research motivation

Several studies tried to shed more light on risk factors favoring young-onset cancer. To date, there is more speculation than strong evidence on what may lead to advanced CRC in young individuals. With our analysis of clinicopathologic parameters we intended to make a contribution to better understand the tumor biology of CRC of the young.

Research objectives

The purpose of this work was to compare histopathologic features of CRC diagnosed in young compared to patients over 50 years of age at our institution.

Research methods

The present study is a monocentric retrospective cohort analysis from a Swiss tertiary center hospital. Patient records covering a time period of 6 year (2013–2018) were included and analyzed according to age based on current CRC screening programs (< 50 and ≥ 50 years of age). The study was approved by the responsible ethics committee.

Research results

The histopathological assessment of the CRC showed a higher proportion of locally advanced tumors in younger patients below 50 years of age. In addition, lymph node metastases were more frequent in young patients with more distant metastases diagnosed among the youngest in our center (< 40 years of age). Mutational status and behavioral risk factors depicted no difference among the groups.

Research conclusions

Patients younger than 50 years of age suffer from more advanced CRC, and show more frequently lymphatic invasion and with more frequent lymphatic metastases than the cohort over 50 years.

Research perspectives

Our study highlights the need to identify young individuals at risk of developing early-onset CRC. Future research should be directed towards identification of individual risk factors for colorectal carcinogenesis at young age and reasons for the early metastatic behavior of tumors in affected patients. Finally, studies such as ours question the current age limit for government-driven CRC screening programs, which may have to start before the age of 50.