624 Early-Onset Colorectal Cancer Diagnosed at a Younger Age Shows Aggressive Features but Favorable Survival
Recommended Citation
Dejban P, Altone I, Chang Q, Lai Z, Kumar S, Ahsan B. 624 Early-Onset Colorectal Cancer Diagnosed at a Younger Age Shows Aggressive Features but Favorable Survival. Lab Invest 2026; 106(3).
Document Type
Conference Proceeding
Publication Date
3-23-2026
Publication Title
Lab Invest
Keywords
adult, age, all cause mortality, cancer staging, colorectal cancer, conference abstract, female, human, incidence, lymph node metastasis, lymph vessel metastasis, major clinical study, male, mortality risk, perineural invasion, retrospective study, surgery, survival analysis
Abstract
Disclosures: Pegah Dejban: None; Imeelda Altone: None; Qing Chang: None; Zongshan Lai: None; Sandeep Kumar: None; Beena Ahsan: None Background: Colorectal cancer (CRC) incidence in younger adults is rising; yet whether patients with early-onset disease substantially differ from patients diagnosed with CRC at older ages is unknown. Comparing CRC features and outcomes across age groups can provide insight into this growing clinical problem. Design: We reviewed the medical records of patients with early-onset (<50 years old) versus later-onset (≥50 years old) CRC treated between 2015 and 2024. Demographic, clinical, and pathologic characteristics were evaluated with univariate two-group comparisons. Kaplan-Meier survival analysis was performed. A multivariable adjusted model was used to identify predictors of all-cause mortality. Results: For 300 patients with CRC (150 early-onset; 150 later-onset), tumor stage and nodal involvement were significantly associated with CRC age group, revealing a higher proportion of younger patients than older patients being diagnosed at tumor stage 4 (28% vs 18%) and having pN1 (35% vs 21%) or pN2 (22% vs 11%) nodal invasion. Also, a significantly higher proportion of younger patients had metastatic disease (18% vs 6%), lymphovascular invasion (43% vs 29%), and perineural invasion (31% vs 13%), while a significantly lower proportion of younger patients died during the study period (20% vs 31%) (all p<.05). Kaplan-Meier analysis showed no significant difference in survival between groups (p=.14). However, adjusting for numerous features, multivariable analysis showed that younger age was a predictor of better survival (adjusted hazard ratio [aHR], 0.49; 95% CI, 0.29-0.81; p=.006), in addition to not having metastatic disease (aHR, 0.27; 95% CI, 0.15-0.49; p<.001) and tumor location being in the left colon, right colon, or rectum. Tumor location in the sigmoid colon was associated with increased risk of death (aHR, 42.74; 95% CI, 3.41-535.85; p=.004) (Table 1). [Formula presented] Conclusions: Although patients with early-onset CRC may present with aggressive pathologic features, patients diagnosed at a younger age may have a higher likelihood of survival. This paradox highlights the complexity of CRC biology across age groups, underscoring the need for refined screening strategies and personalized care.
Volume
106
Issue
3
