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
Abstract
BACKGROUND

In recent years, a decrease in incidence and mortality of colorectal cancer (CRC) has been observed in developed nations, presumably through public disease awareness and increased screening efforts. However, a rising incidence of CRC in young patients below the age of 50 years has been reported in several studies.

AIM

To study tumor biology in CRC patients below 50 years of age.

METHODS

All patients with CRC were prospectively enrolled in our single-center oncologic database from January 2013 to December 2018 and were grouped and analyzed according to age (≥ 50 and < 50 years). Clinical as well as histopathological features were analyzed and compared. The study was approved by the local Ethics Committee. Fisher’s exact test or t-test was used to test for differences between the groups, as appropriate. All statistical analysis was performed with IBM SPSS software Version 25 (SPSS Inc, Armonk, NY, United States) and with R-Studio using R Version 3.4.1 (RStudio, Boston, MA, United States).

RESULTS

Seventeen percent of the 411 patients were younger than 50 years. Young patients were more often diagnosed with locally advanced T4-tumors and lymph node metastases (36.6% and 62% vs 17.7% and 42%; P < 0.01). In addition, a higher frequency of poorly differentiated (G3) tumors (40% vs 22.4% P < 0.05) was observed. More than every second patient below 40 years of age (51.8%) had distant metastases at diagnosis with a significant higher rate ring of signet cell differentiation compared to patients ≥ 50 years (14.8%, P < 0.05). Mutational status (KRAS, NRAS, BRAF, MSI) as well as selected behavioral risk factors showed no significant differences.

CONCLUSION

Distinct histopathologic features of increased biologic aggressiveness are found in patients with CRC of young-onset. Those patients present more frequently with more advanced tumor stages compared to older patients. Features of aggressive tumor biology underscore the need for earlier uptake of routine screening measures.

Keywords: Young-onset colorectal cancer, Tumor biology, Colorectal surgery, Tumor aggressiveness, Colorectal cancer, Colorectal cancer screening

Core Tip: We evaluated differences in tumor biology between young-onset colorectal cancer patients (< 50 years of age) and late-onset colorectal cancer (CRC) patients (≥ 50 years of age) in a Swiss tertiary cancer center over a six-year period. Parameters of interest included clinical as well as histopathological characteristics. This study reports a surprisingly high rate of CRC of young-onset, while affected patients present more frequently with locally advanced tumors, lymphatic invasion and with more frequent lymphatic metastases. This work puts cancer incidence in relation to histopathological details, mutational status, surgical parameters and selected risk factors.