JCO Global Oncology (Jun 2024)

Clinicopathologic Profile and Treatment Outcomes of Colorectal Cancer in Young Adults: A Multicenter Study From India

  • Amit Sehrawat,
  • Mridul Khanna,
  • Smita Kayal,
  • Deepak Sundriyal,
  • Shraddha Tiwari,
  • Sunu Cyriac,
  • Praveen Ravishankaran,
  • Jomon Raphael,
  • Dominic Mathew,
  • Soumya Surath Panda,
  • Laltendu Moharana,
  • Sumit Subhadarshi Mohanty,
  • Swati Sucharita Mohanty,
  • Ashwin Philips,
  • Deepak Jain,
  • Pamela Jeyaraj,
  • Parvez Haque David,
  • Jaineet Patil,
  • S.V. Saju,
  • Krishnakumar Rathnam,
  • Neha Sharma,
  • Kaaviya Dheva,
  • Sree Rekha Jinkala,
  • Kalyarasaran Raja,
  • Prasanth Penumadu,
  • Prasanth Ganesan

DOI
https://doi.org/10.1200/GO.23.00225
Journal volume & issue
no. 10

Abstract

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PURPOSEColorectal cancer (CRC) in young adults is a rising concern in developing countries such as India. This study investigates clinicopathologic profiles, treatment patterns, and outcomes of CRC in young adults, focusing on adolescent and young adult (AYA) CRC in a low- and middle-income country (LMIC).METHODSA retrospective registry study from January 2018 to December 2020 involved 126 young adults (age 40 years and younger) with CRC. Patient demographics, clinical features, tumor characteristics, treatment modalities, and survival outcomes were analyzed after obtaining institutional ethics committees' approval.RESULTSAmong 126 AYA patients, 62.70% had colon cancer and 37.30% had rectal cancer. Most patients (67%) were age 30-39 years, with no significant gender predisposition. Females had higher metastatic burden. Abdominal pain with obstruction features was common. Adenocarcinoma (65%) with signet ring differentiation (26%) suggested aggressive behavior. Limited access to molecular testing hindered mutation identification. Capecitabine-based chemotherapy was favored because of logistical constraints. Adjuvant therapy showed comparable recurrence-free survival in young adults and older patients. For localized colon cancer, the 2-year median progression-free survival was 74%, and for localized rectal cancer, it was 18 months. Palliative therapy resulted in a median overall survival of 33 months (95% CI, 18 to 47). Limited access to targeted agents affected treatment options, with only 27.5% of patients with metastatic disease receiving them. Chemotherapy was generally well tolerated, with hematologic side effect being most common.CONCLUSIONThis collaborative study in an LMIC offers crucial insights into CRC in AYA patients in India. Differences in disease characteristics, treatment patterns, and limited access to targeted agents highlight the need for further research and resource allocation to improve outcomes in this population.