ArticleBMC gastroenterology2026
Clinicopathological characteristics and stage-adjusted outcomes of sporadic pMMR/MSS early-onset colorectal cancer.
Article in BMC gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe global incidence of early-onset colorectal cancer (EOCRC) is increasing. The prognostic impact of EOCRC remains controversial, as it is largely confounded by hereditary syndromes and mismatch repair deficient (dMMR)/microsatellite instability-high (MSI-H) tumors. We aimed to evaluate the clinicopathological features and stage-adjusted outcomes of sporadic, proficient MMR/microsatellite stable (pMMR/MSS) EOCRC.
methodsWe retrospectively reviewed 1,600 consecutive patients who underwent primary tumor resection for Stage 0-IV CRC. After excluding patients with known hereditary cancer syndromes or inflammatory bowel disease (IBD)-related CRC, as well as those with dMMR/MSI-H tumors or unknown MMR/MSI status, 1,218 patients with sporadic pMMR/MSS CRC were analyzed. Patients were stratified into EOCRC (< 50 years, n = 86) and late-onset CRC (LOCRC, ≥ 50 years, n = 1,132) cohorts. Cancer-specific survival (CSS) and time to recurrence (TTR) were evaluated.
resultsPatients with EOCRC were more often diagnosed at an advanced stage than those with LOCRC (P < 0.001). Unadjusted CSS was worse in the EOCRC group (P = 0.042); however, multivariable analysis showed that EOCRC was not an independent predictor of worse CSS (adjusted hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.49-1.37, P = 0.512). Among 987 patients with curatively resected Stage I-III disease, the EOCRC group received significantly more intensive perioperative treatments (P < 0.001). Unadjusted TTR did not significantly differ between the age groups (P = 0.510), and multivariable analysis showed a non-significant tendency toward a lower recurrence risk in patients with EOCRC (adjusted HR 0.52, 95% CI 0.23-1.03, P = 0.084).
conclusionsAfter exclusion of hereditary syndromes, IBD-related CRC, and dMMR/MSI-H tumors, pMMR/MSS EOCRC more often presented with advanced disease, but its stage-adjusted cancer-specific survival and recurrence outcomes did not significantly differ from those of LOCRC.
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