Brooke Army Medical Center San Antonio, TX, United States
Matthew Schwartz, MD1, Jessica E. Basso, MD1, Jerome Edelson, MD1, Brandon W. Kuiper, MD2, Anish Patel, DO1 1Brooke Army Medical Center, San Antonio, TX; 2Brooke Army Medical Center, Fort Sam Houston, TX
Introduction: Increasing rates of early onset CRC (EOCRC) in those less than 50 years old have recently been described. While current evidence suggests the etiology of EOCRC is multifactorial, specific risk factors have not been widely studied. We sought to identify clinically relevant factors associated with higher grade (stage IV) CRC presentation to better describe this population.
Methods: Using ICD codes, we identified a cohort of patients diagnosed with CRC at an age of 18–49 years who received treatment within the Department of Defense health care system from January 1, 1995 through January 1, 2021. We performed manual chart review to ascertain patient characteristics. Statistical analysis was performed to contrast patients with high grade (stage IV) CRC and those diagnosed with lower grade (stage I-III) CRC.
Results: We identified 75 patients with EOCRC, of which 55 had initial presentations of low grade CRC, and 20 with high grade CRC. There was no significant difference in gender, race, or age between the two groups. The combined mean age at presentation was 39, and 60% were male. Prevalence of established CRC risk factors of obesity, IBD history, family history, and diabetes were not significantly distinct between groups. Majority of low grade (72.7%) and high grade (90%) cancers presented as rectal or left sided malignancies.
High grade CRC patients were more likely to be symptomatic at diagnosis, but were less frequently associated with active PPI use (odds ratio [OR] 0.17; 95% CI, 0.02-1.39) and less likely to have a smoking history when compared to those with lower grade CRC. Additionally, laboratory studies in high grade patients were significantly associated with leukocytosis, thrombocytosis, elevated INR, hyponatremia, hypochloremia, higher average serum calcium and elevated CEA (P< 0.05).
Discussion: In a retrospective study of adult patients diagnosed with early onset CRC, we identified factors more frequently associated with high grade (stage IV) cancer. Our studies demonstrated a preponderance of left sided and rectal cancers which is consistent with other studies of EOCRC. Interestingly, there was a statistically significant inverse relationship between smoking, PPI use and higher stage at diagnosis.
Figure: Figure 1: Results of significant laboratory testing when comparing high grade (Blue, stage IV on diagnosis) early onset colorectal cancer (EOCRC) versus lower grade (Gray, stage I-III at diagnosis) EOCRC.
Figure 2: Rates of early onset colorectal cancer (EOCRC) by location and rates of significant factors when contrasting lower grade (stage I-III) versus high grade (stage IV) EOCRC. Data are prescribed as percentages.
Disclosures: Matthew Schwartz indicated no relevant financial relationships. Jessica Basso indicated no relevant financial relationships. Jerome Edelson indicated no relevant financial relationships. Brandon Kuiper indicated no relevant financial relationships. Anish Patel indicated no relevant financial relationships.
Matthew Schwartz, MD1, Jessica E. Basso, MD1, Jerome Edelson, MD1, Brandon W. Kuiper, MD2, Anish Patel, DO1. P2344 - Early Onset Colorectal Neoplasia: Trends in Demographics and Risk Factors, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.