Age-related rates of colorectal cancer and the factors associated with overall survival

Background: The purpose of this study was to identify differences in both demographic and pathologic factors associated with the age-related rates of colorectal cancer (CRC) and overall survival (OS). Methods: The National Cancer Data Base (NCDB), 2004-2013, was queried for patients with CRC. Patients were stratified by age (<= 50 vs. >= 60 years). Multivariable analysis was performed to identify factors associated with OS. Results: A total of 670,030 patients were included; 488,121 with colon, and 181,909 with rectal or rectosigmoid cancer. For colon cancer, patients <= 50 years had higher proportions of pathologic stage III and IV disease than patients >= 60 (III: 33.7% vs. 28.6%, IV: 25.5% vs. 14.3%, respectively; P <= 0.001). Similar differences were found for patients with rectal cancer (III: 35.8% vs. 28.6%, IV: 16.5% vs. 11.6%, respectively for age <= 50 and >= 60 years; P <= 0.001). More aggressive pathologic factors were identified in the <= 50 cohort and were associated with worse OS, including higher tumor grade, lymphovascular invasion (LVI), perineural invasion (PNI), and elevated serum carcinoembryonic antigen (CEA). Disparities associated with OS were also identified for both colon and rectal cancer. For patients <= 50 with CRC, African-American and Hispanic race, lower income and lower education were associated with increased risk of mortality compared to the >= 60 cohort. Conclusions: There are clear differences in biological factors and in racial and socioeconomic disparities of patients with early onset CRC. Earlier screening should be seriously considered in patients under 50 years who are African-American and Hispanic, as these populations present with more aggressive and advanced disease.