Risk of Metachronous Neoplasia in Early-onset Colorectal Cancer: Meta-analysis

Overview

Journal BJS Open

Publisher Oxford University Press

Specialty General Surgery

Date 2024 Sep 4

PMID 39230922

Authors

Gianluca Pellino

Giacomo Fuschillo

Rogelio Gonzalez-Sarmiento

Marc Marti-Gallostra

Francesco Selvaggi

Eloy Espin-Basany

Jose Perea

Affiliations

Soon will be listed here.

Abstract

Background: Metachronous colorectal cancer refers to patients developing a second colorectal neoplasia diagnosed at least 6 months after the initial cancer diagnosis, excluding recurrence. The aim of this systematic review is to assess the incidence of metachronous colorectal cancer in early-onset colorectal cancer (defined as age at diagnosis of less than 50 years) and to identify risk factors.

Methods: This is a systematic review and meta-analysis performed following the PRISMA statement and registered on PROSPERO. The literature search was conducted in PubMed and Embase. Only studies involving patients with early-onset colorectal cancer (less than 50 years old) providing data on metachronous colorectal cancer were included in the analysis. The primary endpoint was the risk of metachronous colorectal cancer in patients with early-onset colorectal cancer. Secondary endpoints were association with Lynch syndrome, family history and microsatellite instability.

Results: Sixteen studies met the inclusion criteria. The incidence of metachronous colorectal cancer was 2.6% (95% c.i. 2.287-3.007). The risk of developing metachronous colorectal cancer in early-onset colorectal cancer versus non-early-onset colorectal cancer patients demonstrated an OR of 0.93 (95% c.i. 0.760-1.141). The incidence of metachronous colorectal cancer in patients with Lynch syndrome was 18.43% (95% c.i. 15.396-21.780), and in patients with family history 10.52% (95% c.i. 5.555-17.659). The proportion of metachronous colorectal cancer tumours in the microsatellite instability population was 19.7% (95% c.i. 13.583-27.2422).

Conclusion: The risk of metachronous colorectal cancer in patients with early-onset colorectal cancer is comparable to those with advanced age, but it is higher in patients with Lynch syndrome, family history and microsatellite instability. This meta-analysis demonstrates the need to personalize the management of patients with early-onset colorectal cancer according to their risk factors.

References

Toh J, Hui N, Collins G, Phan K . Survival outcomes associated with Lynch syndrome colorectal cancer and metachronous rate after subtotal/total versus segmental colectomy: Meta-analysis. Surgery. 2022; 172(5):1315-1322. DOI: 10.1016/j.surg.2022.06.013. View

Klos C, Montenegro G, Jamal N, Wise P, Fleshman J, Safar B . Segmental versus extended resection for sporadic colorectal cancer in young patients. J Surg Oncol. 2014; 110(3):328-32. DOI: 10.1002/jso.23649. View

Fitzmaurice C, Allen C, Barber R, Barregard L, Bhutta Z, Brenner H . Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncol. 2016; 3(4):524-548. PMC: 6103527. DOI: 10.1001/jamaoncol.2016.5688. View

Win A, Parry S, Parry B, Kalady M, Macrae F, Ahnen D . Risk of metachronous colon cancer following surgery for rectal cancer in mismatch repair gene mutation carriers. Ann Surg Oncol. 2013; 20(6):1829-36. PMC: 4041733. DOI: 10.1245/s10434-012-2858-5. View

Provenzale D, Gupta S, Ahnen D, Markowitz A, Chung D, Mayer R . NCCN Guidelines Insights: Colorectal Cancer Screening, Version 1.2018. J Natl Compr Canc Netw. 2018; 16(8):939-949. DOI: 10.6004/jnccn.2018.0067. View

Perea Garcia J, Arribas J, Canete A, Garcia J, Alvaro E, Tapial S . Association of Polyps with Early-Onset Colorectal Cancer and Throughout Surveillance: Novel Clinical and Molecular Implications. Cancers (Basel). 2019; 11(12). PMC: 6966640. DOI: 10.3390/cancers11121900. View

Walker P, Platell C . Long-term Outcomes of Surgery for Colorectal Cancer: A 20-Year Study. J Surg Res. 2019; 235:34-43. DOI: 10.1016/j.jss.2018.09.026. View

Kim H, Cho Y, Cha J, Shin J, Kim K, Yang H . Risk of metachronous neoplasia on surveillance colonoscopy in young patients with colorectal neoplasia. Gastrointest Endosc. 2017; 87(3):666-673. DOI: 10.1016/j.gie.2017.05.053. View

Myers E, Feingold D, Forde K, Arnell T, Jang J, Whelan R . Colorectal cancer in patients under 50 years of age: a retrospective analysis of two institutions' experience. World J Gastroenterol. 2013; 19(34):5651-7. PMC: 3769901. DOI: 10.3748/wjg.v19.i34.5651. View

10.

Zhang Y, Karahalios A, Aung Y, Win A, Boussioutas A, Jenkins M . Risk factors for metachronous colorectal cancer and advanced neoplasia following primary colorectal cancer: a systematic review and meta-analysis. BMC Gastroenterol. 2023; 23(1):421. PMC: 10688466. DOI: 10.1186/s12876-023-03053-2. View

11.

Enwerem N, Cho M, Demb J, Earles A, Heskett K, Liu L . Systematic Review of Prevalence, Risk Factors, and Risk for Metachronous Advanced Neoplasia in Patients With Young-Onset Colorectal Adenoma. Clin Gastroenterol Hepatol. 2020; 19(4):680-689.e12. PMC: 7702214. DOI: 10.1016/j.cgh.2020.04.092. View

12.

Bruinvels D, Stiggelbout A, Kievit J, van Houwelingen H, Habbema J, van de Velde C . Follow-up of patients with colorectal cancer. A meta-analysis. Ann Surg. 1994; 219(2):174-82. PMC: 1243119. DOI: 10.1097/00000658-199402000-00009. View

13.

Siegel R, Torre L, Soerjomataram I, Hayes R, Bray F, Weber T . Global patterns and trends in colorectal cancer incidence in young adults. Gut. 2019; 68(12):2179-2185. DOI: 10.1136/gutjnl-2019-319511. View

14.

Benson A, Venook A, Al-Hawary M, Cederquist L, Chen Y, Ciombor K . NCCN Guidelines Insights: Colon Cancer, Version 2.2018. J Natl Compr Canc Netw. 2018; 16(4):359-369. PMC: 10184502. DOI: 10.6004/jnccn.2018.0021. View

15.

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

16.

Kim T, Ran Kim E, Hong S, Kyung Chang D, Kim Y . Long-Term Outcome and Prognostic Factors of Sporadic Colorectal Cancer in Young Patients: A Large Institutional-Based Retrospective Study. Medicine (Baltimore). 2016; 95(19):e3641. PMC: 4902524. DOI: 10.1097/MD.0000000000003641. View

17.

Aronson M, Holter S, Semotiuk K, Winter L, Pollett A, Gallinger S . DNA Mismatch Repair Status Predicts Need for Future Colorectal Surgery for Metachronous Neoplasms in Young Individuals Undergoing Colorectal Cancer Resection. Dis Colon Rectum. 2015; 58(7):645-52. DOI: 10.1097/DCR.0000000000000391. View

18.

Parry S, Win A, Parry B, Macrae F, Gurrin L, Church J . Metachronous colorectal cancer risk for mismatch repair gene mutation carriers: the advantage of more extensive colon surgery. Gut. 2011; 60(7):950-7. PMC: 3848416. DOI: 10.1136/gut.2010.228056. View

19.

Kim S, Lee H, Park S, Hong S, Cheon J, Kim W . Comparison of Colonoscopy Surveillance Outcomes Between Young and Older Colorectal Cancer Patients. J Cancer Prev. 2017; 22(3):159-165. PMC: 5624456. DOI: 10.15430/JCP.2017.22.3.159. View

20.

Tian Y, Xin Y, Li S . Risk Stratification Based on Synchronous Neoplasia and Clinical Physicochemical Characteristics Predicts a Higher Incidence of Metachronous Advanced Neoplasia in Patients Undergoing Colorectal Resection for Colorectal Cancer. Cancer Manag Res. 2020; 12:11295-11307. PMC: 7652221. DOI: 10.2147/CMAR.S271614. View