Faruk Recep ÖZALP, Özge YETGİNOĞLU, Şerife SİVRİDEMİR, Erkut DEMİRCİLER, Oktay Halit AKTEPE, Hüseyin Salih SEMİZ, Aziz KARAOĞLU
Journal of Medicine and Palliative Care - 2026;7(4):764-771
Aims: To analyze the clinicopathological features and survival outcomes of early-onset colon cancer (EOCC, <50 years) compared with late-onset colon cancer (LOCC, >=50 years) in a large curative-intent surgical cohort. Methods: We retrospectively analyzed 156,031 stage I-III colon cancer patients from the SEER database (2010-2015 and 2018-2022) who underwent therapeutic surgical resection. Patients with stage 0/IV , appendiceal tumors, or unknown staging were excluded. Clinicopathological characteristics and cause-specific survival (CSS) were compared. Multivariable Cox proportional hazards regression was performed to identify independent prognostic factors. Results: EOCC accounted for 9.0% (n=14,028) of the curative surgical population. The proportion of EOCC significantly increased from 8.4% in 2010 to 11.6% in 2022 (p<0.001 for trend). EOCC patients were more likely to present with stage III disease (45.2% vs. 33.8%), distal tumor location (57.5% vs. 37.2%), and higher perineural invasion (12.9% vs. 8.9%) (p<0.001 for all). Despite advanced presentation, EOCC demonstrated superior 5-year CSS (88.1% vs. 81.4%, log-rank p<0.001). After multivariable adjustment, EOCC was associated with a 42.3% lower risk of cancer-specific death (HR: 0.577; 95% CI: 0.548-0.608; p<0.001). Conclusion: In this curative-intent surgical cohort, the proportion of EOCC increased over time. Although EOCC was associated with more advanced stage and adverse pathological features, younger age remained associated with better CSS after multivariable adjustment.
