Causes of death among early-onset colorectal cancer population in the United States: a large population-based study

Yuerong Chen; Lanping He; Xiu Lu; Yuqun Tang; Guanshui Luo; Yuji Chen; Chaosheng Wu; Qihua Liang; Xiuhong Xu

doi:10.3389/fonc.2023.1094493

Causes of death among early-onset colorectal cancer population in the United States: a large population-based study

Front Oncol. 2023 Apr 24:13:1094493. doi: 10.3389/fonc.2023.1094493. eCollection 2023.

Authors

Yuerong Chen¹, Lanping He², Xiu Lu¹, Yuqun Tang¹, Guanshui Luo¹, Yuji Chen¹, Chaosheng Wu¹, Qihua Liang³, Xiuhong Xu⁴

Affiliations

¹ Minimally Invasive Tumor Therapies Center, Guangdong Second Provincial General Hospital, Guangzhou, China.
² Department of Gastroenterology, Fogang County People's Hospital, Fogang, China.
³ Center of Digestive Endoscopology, The Second People's Hospital of Luoding City, Luoding, China.
⁴ Department of Acupuncture and Massage Rehabilitation, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China.

Abstract

Background: Early-onset colorectal cancer (EOCRC) has an alarmingly increasing trend and arouses increasing attention. Causes of death in EOCRC population remain unclear.

Methods: Data of EOCRC patients (1975-2018) were extracted from the Surveillance, Epidemiology, and End Results database. Distribution of death was calculated, and death risk of each cause was compared with the general population by calculating standard mortality ratios (SMRs) at different follow-up time. Univariate and multivariate Cox regression models were utilized to identify independent prognostic factors for overall survival (OS).

Results: The study included 36,013 patients, among whom 9,998 (27.7%) patients died of colorectal cancer (CRC) and 6,305 (17.5%) patients died of non-CRC causes. CRC death accounted for a high proportion of 74.8%-90.7% death cases within 10 years, while non-CRC death (especially cardiocerebrovascular disease death) was the major cause of death after 10 years. Non-cancer death had the highest SMR in EOCRC population within the first year after cancer diagnosis. Kidney disease [SMR = 2.10; 95% confidence interval (CI), 1.65-2.64] and infection (SMR = 1.92; 95% CI, 1.48-2.46) were two high-risk causes of death. Age at diagnosis, race, sex, year of diagnosis, grade, SEER stage, and surgery were independent prognostic factors for OS.

Conclusion: Most of EOCRC patients died of CRC within 10-year follow-up, while most of patients died of non-CRC causes after 10 years. Within the first year after cancer diagnosis, patients had high non-CRC death risk compared to the general population. Our findings help to guide risk monitoring and management for US EOCRC patients.

Keywords: cause of death; early-onset colorectal cancer; prognostic factor; surveillance; survivorship.

Grants and funding

This work was supported by the President Foundation of Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, No. 1202102004.