Heterogeneity in survival within age groups of early‐onset colorectal cancer patients: A National Cancer Database analysis

Background We aimed to identify predictors of and heterogeneity in survival among different age groups of patients with early‐onset colorectal cancer (EOCRC). Methods This retrospective cohort study used National Cancer Database data from 2004 to 2019. Differences in survival among CRC patients <50 years, subcategorized into age groups (<20, 20–29, 30–39, 40–49 years) were compared for demographic, clinical, and histologic features by univariate and multivariate analyses. Cox hazard regression and Kaplan Meier survival analysis were performed. Results 134 219 of the 1 240 787 individuals with CRC (10.8%) were <50 years old; 46 639 (34.8%) had rectal and 87 580 (65.3%) had colon cancer. Within the colon cancer cohort, individuals aged between 30 and 39 years had the highest overall survival rate (66.7%) during a median follow‐up of 47.6 months (interquartile range IQR 23.1–89.7). The same age group in the rectal cancer cohort had the lowest survival rate (31%) over a median follow‐up of 54.5 (IQR 28.24–97.31) months. Leading factors affecting survival included tumor stage (HR 8.23 [4.64–14.6]; p < 0.0001), lymphovascular invasion (HR 1.88 [1.70–2.06]; p < 0.0001) and perineural invasion (HR 1.08 [1.02–1.15]; p = 0.001). Conclusion Survival trends vary within age groups of patients affected with early onset colon cancer compared to rectal cancer. Tumor stage and unfavorable pathological characteristics are the strongest factors predicting survival.