Do Young Patients Have Different Pathological Features Resulting in Worse Oncological Outcomes?

Early-onset colorectal cancer (EOCRC) may differ clinically and oncologically from later-onset disease. This retrospective cohort study compared surgically treated patients with stage I–IV colorectal adenocarcinoma diagnosed at age < 50 vs. ≥ 50 years at a tertiary center between 2010 and 2020. Clinical, pathological, perioperative, and oncological outcomes were compared. Survival was evaluated using Kaplan–Meier analysis and Cox proportional hazards regression. Of 434 patients, 78 (17.97%) were aged < 50 years and 356 (82.03%) were aged ≥ 50 years. Mean (SD) follow-up was 35.59 (16.27) months. Patients aged < 50 years had shorter hospital stays (prevalence ratio [PR], 0.11; 95% CI, 0.01–0.21; p = 0.0336) but exhibited a higher prevalence of undifferentiated tumors (PR, 2.38; 95% CI, 1.18–4.78; p = 0.0147) and a 93% higher risk of recurrence (hazard ratio [HR], 1.93; 95% CI, 1.00–3.72; p = 0.0483) than those aged ≥ 50 years. No significant age-related difference was observed in overall survival, symptom–to–diagnosis interval, or pathological stage. EOCRC was associated with undifferentiated histology and a higher risk of disease recurrence. Further studies incorporating treatment information and molecular tumor characteristics are needed to clarify the independent prognostic significance of age in EOCRC.