Differences in treatment and outcomes between young and older patients with colorectal cancer liver metastases: an AmCORE-based study

Background The incidence of early-onset colorectal cancer (eoCRC, <50 years) is rising, whereas late-onset CRC (loCRC, ≥70 years) is increasingly prevalent due to demographic shifts. CRC commonly metastasizes to the liver, impacting progression-free survival (PFS) and overall survival (OS). Current guidelines are mainly based on patients aged 50-70 years, and little is known about treatment and outcomes in younger and older patients with colorectal liver metastases (CRLM).Therefore, we compared treatment strategies and outcomes between eoCRC and loCRC patients with CRLM. Patients and methods Patients receiving their first local treatment of CRLM between 2018 and 2023 at Amsterdam UMC were extracted from the AmCORE registry and subdivided into three age groups: <50, 50-69, and ≥70 years. Primary and secondary endpoints were PFS and OS, respectively. Firth logistic regression evaluated factors influencing treatment choice. Results In total, 351 patients were included: 31 aged <50, 164 aged 50-69, and 156 aged ≥70. Younger patients received significantly more induction chemotherapy before first local treatment than those aged ≥70 and 50-69 ( P < 0.001) and presented more frequently with a higher number of CRLM ( P = 0.026). PFS was significantly shorter in patients <50 ( P = 0.019), whereas OS did not differ significantly between age groups ( P = 0.22). A larger number and size of CRLM were associated with an increased likelihood of induction systemic treatment. Conclusions Despite receiving more intensive treatment, younger patients did not show better outcomes: PFS was poorer and OS was similar compared with older patients. This may be explained by greater disease burden at presentation rather than intrinsically aggressive tumor biology.