To define the prognosis of colorectal cancer (CRC) in young patients and to compare their postoperative treatment with that of older patients.
This multicenter study enrolled 5457 patients with primary CRC who underwent surgical resection. The overall survival, clinicopathologic characteristics and postoperative treatment of 253 young patients aged 18-44 years and 5204 older patients aged 44-80 years were analyzed.
The overall survival rate was 77.1% for young and 74.2% for older patients (P = 0.348). Landmark analysis showed a significant difference in survival between young and older patients, with 63.8% of the deaths among young patients being within 25 months of surgery compared to 42.4% among older patients (P= 0.002). Among those who survived more than 25 months, young patients had significantly better survival than older patients (P= 0.009). Multivariable analysis of young patients revealed that the tumor location, perineural invasion and stage were associated with poor survival within 25 months; after this period, stage was the only prognostic marker. Young patients were more likely to receive chemotherapy, particularly multiagent regimens. For young patients, no significant difference in overall survival was found based on the chemotherapy regimen, regardless disease stage (II, III or IV, all P > 0.05). Additionally, unlike in older patients, no difference in overall survival was found in young patients regardless of the drug regimen administered (all P > 0.05).
Young-onset CRC may have a unique disease biology that warrants further research and therapy development.