Snapshot cohort study on early-onset colorectal cancer in Northwestern Switzerland: are we doing enough or can we do more?

[BACKGROUND] Early-onset colorectal cancer (EOCC), defined as CRC in patients under 50, is rising alarmingly in Western countries. This study explores key differences in clinical profiles, socioeconomic factors, and oncological treatments between EOCC and later-onset colorectal cancer (LOCC) patients.

[PATIENTS AND METHODS] This multicenter cohort study analyzed CRC patients treated from January 2023 to June 2024 at 11 centers in Northwestern Switzerland. Patients with confirmed CRC were included, while exclusions applied to secondary CRC, unconfirmed cases, and those unable to consent. Statistical analyses included descriptive methods, Fisher's exact test, Kruskal-Wallis tests, and logistic regression ( P ≤ 0.05).

[RESULTS] Among 764 patients, 10.5% had EOCC and 89.5% LOCC. Mean age was 42.1 for EOCC and 70.8 for LOCC. EOCC patients were more often non-Swiss (67.5% vs. 32.2%, P < 0.001), faced greater financial hardship ( P < 0.001), consumed more glucose (>5 units/week) (48.8% vs. 35.2%, P = 0.02), and had more second-degree relatives with CRC ( P = 0.05). EOCC symptoms included abdominal pain (54.6%) and rectal bleeding (50.6%), while LOCC presented with rectal bleeding (35.4%) and bowel habit changes (25.3%). EOCC had longer diagnostic delays (7.2 vs. 4.2 months, P = 0.03) and reached a higher UICC stage (IIIC vs. IIIA). Adjuvant therapy was more frequent in EOCC for colon (52.4% vs. 35.2%, P = 0.04) and rectal cancer (58.3% vs. 33.3%, P = 0.02). Defunctioning ostomies were more common in EOCC (13.2% vs. 3.2%, P = 0.01). EOCC had shorter hospital stays (8.66 vs. 11.43 days, P = 0.05), but intensive care unit stays, complications, lymph node retrieval, and operation times were similar.

[CONCLUSION] These findings emphasize the need for tailored screening protocols and personalized management strategies to address the unique challenges faced by patients under 50 and to improve outcomes.