The mortality risk in patients with early onset colorectal cancer: the role of comorbidities

Abstract

The global incidence of early-onset colorectal cancer (EO-CRC) is increasing. Although the mortality rate is relatively stable, some comorbidities have been associated with a higher mortality rate. This study estimated the mortality risk in patients with EO-CRC with various comorbidities using real-world data to identify the high-risk group using Cox proportional regression for overall and cancer-specific mortality. The incidence rate of EO-CRC significantly increased from 6.04 per 100,000 population in 2007 to 12.97 per 100,000 population in 2017. The five-year overall mortality rate was 101.50 per 1000 person year and the cancer-specific mortality rate was 94.12 per 1000 person year. Patients with cerebrovascular disease (CVD) had a higher mortality risk (hazard ratio (HR): 1.68; 95% confidence interval (CI): 1.25-2.28; p=0.0007). After subgroup analyses based on age, sex, clinical stage, and treatment type, patients with CVD had a higher overall mortality risk compared to non-CVD patients, except for patients undergoing surgery and chemotherapy. Patients with chronic kidney disease had a higher mortality risk in the early clinical stages (HR: 2.31; 95% CI: 1.08-4.96; p=0.0138). Patients who underwent radiotherapy had a higher overall mortality risk (HR: 1.38; 95% CI: 1.04-1.85; p=0.0285) than those without liver disease. Identifying specific comorbidity mortality risks in patients with EO-CRC allows for risk stratification when screening target groups and may lower disease mortality.

Keywords: Taiwan cancer registry; comorbidities; early-onset colorectal cancer; mortality risk; real-world database (RWD).