Incidence and survival trends in early-onset colorectal cancer.

e15713 Background: Early-onset colorectal cancer (EOCRC) is colorectal cancer that occurs in people under the age of 50 and represents an emerging public health concern with increasing incidence rates worldwide. The incidence of colorectal cancer in young adults has been rising globally over the past two decades. This study analyzes demographic patterns, risk factors, and survival trends in a cohort of 413 EOCRC patients. Methods: This study retrospectively analyzed 413 patients diagnosed with EOCRC from TriNetX database. Clinical data included disease stage, treatment modalities, and survival outcomes, with an event rate of 40% and a median follow-up time of approximately 26 months. Age-stratified survival analysis revealed distinct patterns across the three age groups examined. Statistical analyses were conducted using Kaplan-Meier methods for survival outcomes and multivariable Cox proportional hazards models to identify prognostic factors. All analyses complied with ethical guidelines and institutional review board requirements. Results: An analysis of 413 patients with early-onset colorectal cancer (EOCRC, ages 21-50, mean: 44 years, SD: 5) revealed distinct age-dependent patterns in incidence, molecular features, and survival. The cohort showed a male predominance (60.29%). HER2 testing was the most common molecular assessment (76%, with 75% undergoing ISH dual probe ratio testing), while KRAS mutation and hormone receptor/PDGFRA analyses were conducted in 4% and 2%, respectively. Testing rates were highest in the youngest ( < 35 years) and oldest (43-50 years) cohorts, suggesting potential age-specific molecular phenotypes. Survival analysis revealed an age-related gradient: younger patients ( < 35 years) had the highest survival rate (64.65%), followed by 57.58% in the middle age group (35-42 years) and 54.31% in the older group (43-50 years). A critical two-year post-diagnosis period showed an initial decline in survival, followed by stabilization. These findings highlight an age-dependent survival advantage in younger EOCRC patients, despite the aggressive nature of the disease. Conclusions: Key learning points include the age-dependent survival advantage observed in younger patients, the importance of comprehensive molecular profiling for personalized treatment, and identifying a critical two-year post-diagnosis period for intervention and monitoring. Future research should focus on elucidating the underlying biological mechanisms driving EOCRC in younger populations, developing targeted prevention strategies, and optimizing treatment protocols to improve long-term outcomes. Additionally, large-scale, multicenter studies are needed to validate these findings and explore the role of emerging therapies in this unique patient population.