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Background <p>The incidence of early-onset colorectal cancer (EOCRC) has increased globally, but its clinical characteristics, treatment patterns, and outcomes remain incompletely characterized, particularly in Asian populations. We compared clinical presentation, treatment patterns, and survival outcomes of EOCRC and late-onset colorectal cancer (LOCRC) in Korea.</p> Methods <p>Using the nationwide K-CURE database, we identified patients diagnosed with colorectal cancer between 2012 and 2019. EOCRC was defined as colorectal cancer diagnosed before 50 years of age. Clinical characteristics, initial treatment patterns, and survival outcomes were compared between EOCRC and LOCRC. Propensity score matching and multivariable Cox proportional hazards regression analyses were performed.</p> Results <p>Among 20,941 patients, 2,044 (9.8%) had EOCRC, and the proportion remained near 10% throughout the study period. Stage distribution and tumor differentiation were comparable between EOCRC and LOCRC. Patients with EOCRC more frequently received multimodality treatment across disease stages. In unadjusted analyses, EOCRC was associated with lower overall mortality (HR, 0.61; 95% CI, 0.56–0.66), cancer-specific mortality (HR, 0.79; 95% CI, 0.72–0.86), and non-cancer mortality (HR, 0.13; 95% CI, 0.09–0.18), with consistent findings in propensity score–matched and multivariable analyses. The mortality difference was greatest in localized disease and remained evident across stages and primary tumor sites. In molecular subgroup analyses, the association between EOCRC and lower mortality was stronger in MSI tumors than in microsatellite-stable tumors, with a significant interaction, whereas no significant interaction was observed according to KRAS mutation status.</p> Conclusions <p>EOCRC was not associated with more advanced disease at diagnosis than LOCRC and was associated with lower observed mortality, which should be interpreted in the context of baseline patient characteristics and treatment patterns.</p>

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Early-onset colorectal cancer in Korea: clinical characteristics, treatment patterns, and survival outcomes in a K-CURE nationwide population-based study

  • 期刊论文

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  • 发表日期：

    2026年7月30日

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  • Kyunghye Bang,
  • Dawoon Jeong,
  • Semie Hong,
  • Hyeon Kang Koh,
  • Ji Hyun Park,
  • Jeong Yun Jang,
  • Kangpyo Kim

摘要

Background

The incidence of early-onset colorectal cancer (EOCRC) has increased globally, but its clinical characteristics, treatment patterns, and outcomes remain incompletely characterized, particularly in Asian populations. We compared clinical presentation, treatment patterns, and survival outcomes of EOCRC and late-onset colorectal cancer (LOCRC) in Korea.

Methods

Using the nationwide K-CURE database, we identified patients diagnosed with colorectal cancer between 2012 and 2019. EOCRC was defined as colorectal cancer diagnosed before 50 years of age. Clinical characteristics, initial treatment patterns, and survival outcomes were compared between EOCRC and LOCRC. Propensity score matching and multivariable Cox proportional hazards regression analyses were performed.

Results

Among 20,941 patients, 2,044 (9.8%) had EOCRC, and the proportion remained near 10% throughout the study period. Stage distribution and tumor differentiation were comparable between EOCRC and LOCRC. Patients with EOCRC more frequently received multimodality treatment across disease stages. In unadjusted analyses, EOCRC was associated with lower overall mortality (HR, 0.61; 95% CI, 0.56–0.66), cancer-specific mortality (HR, 0.79; 95% CI, 0.72–0.86), and non-cancer mortality (HR, 0.13; 95% CI, 0.09–0.18), with consistent findings in propensity score–matched and multivariable analyses. The mortality difference was greatest in localized disease and remained evident across stages and primary tumor sites. In molecular subgroup analyses, the association between EOCRC and lower mortality was stronger in MSI tumors than in microsatellite-stable tumors, with a significant interaction, whereas no significant interaction was observed according to KRAS mutation status.

Conclusions

EOCRC was not associated with more advanced disease at diagnosis than LOCRC and was associated with lower observed mortality, which should be interpreted in the context of baseline patient characteristics and treatment patterns.