Characterizing symptom patterns in early-onset colorectal cancer: insights from a national inpatient analysis

IF 3.5 Q3 Medicine

Cancer treatment and research communications Pub Date : 2026-01-01 Epub Date: 2026-06-13 DOI:10.1016/j.ctarc.2026.101287

Ashish Samaddar , Suriya Basker , Sawyer Bawek , Udhayvir Grewal , Timothy J Brown , Sepideh Gholami , Lingzhi Liu , Deepak Vadehra , Nicholas Hornstein

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引用次数: 0

Abstract

Background

While colorectal cancer (CRC) incidence overall is declining, early-onset CRC (EOCRC, diagnosed before age 50) continues to rise. In response, screening guidelines were lowered from age 50 to 45 in 2021. However, many EOCRC cases still occur under age 45, highlighting the need to identify high-risk individuals beyond current criteria. We hypothesized that EOCRC presents with distinct symptom profiles compared to late-onset CRC (LOCRC).

Methods

We analyzed 2020–2022 National Inpatient Sample data, performing 1:1 age-matched comparisons between CRC patients and controls without CRC. Symptoms were defined using ICD-10 codes. Adjusted odds ratios (aORs) were calculated and stratified by age and sex. Bonferroni correction was applied for 12 symptom groups (p < 0.004).

Results

Among 18,017 EOCRC hospitalizations, several symptoms demonstrated differential associations compared to LOCRC, including constipation, iron-deficiency anemia, and hematochezia. Data-driven stratification revealed that constipation showed the strongest divergence between EOCRC and LOCRC (aOR 2.50 vs. 1.12), particularly among women under 40 (aOR 5.72; p < 0.001). Colon cancer was identified in 1.31% of constipation-related hospitalizations in adults aged 40–44, comparable to the 1.07% incidence among all hospitalizations in adults 45–49.

Conclusions

Symptom pattern analysis from a large national inpatient cohort demonstrates distinct clinical presentations of EOCRC. Constipation showed a stronger association in younger adults, particularly women, suggesting a potential role in identifying higher-risk presentations. However, these findings reflect hospitalized encounters and may be enriched for patients with more advanced or complicated disease rather than early-stage detection. Importantly, despite significant relative associations, the absolute prevalence of colorectal cancer among constipation-related hospitalizations remained low, underscoring the need for cautious interpretation and further prospective validation.

Micro Abstract

EOCRC: In this unstructured, symptom-driven national analysis, constipation emerged as a disproportionately stronger association with early-onset colorectal cancer (EOCRC) than with late-onset disease. These findings suggest that data-driven symptom evaluation can uncover clinically relevant signals to inform earlier recognition and diagnosis of EOCRC.

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表征早发性结直肠癌的症状模式：来自全国住院患者分析的见解

虽然结直肠癌（CRC）的总体发病率正在下降，但早发性CRC （EOCRC，在50岁之前诊断）的发病率仍在上升。因此，2021年筛查指南从50岁降至45岁。然而，许多EOCRC病例仍然发生在45岁以下，这突出了识别现有标准之外的高危个体的必要性。我们假设与晚发性CRC （LOCRC）相比，eoccrc表现出不同的症状特征。方法分析2020-2022年全国住院患者样本数据，在结直肠癌患者和非结直肠癌对照组之间进行1:1年龄匹配比较。使用ICD-10代码定义症状。计算校正优势比（aORs）并按年龄和性别分层。12个症状组采用Bonferroni校正（p < 0.004）。结果在18017例EOCRC住院患者中，与LOCRC相比，几种症状表现出不同的相关性，包括便秘、缺铁性贫血和便血。数据驱动的分层显示，便秘在EOCRC和LOCRC之间的差异最大（aOR为2.50 vs. 1.12），特别是在40岁以下的女性中（aOR为5.72;p < 0.001）。在40-44岁的成年人中，结肠癌的发生率为1.31%，而在45-49岁的成年人中，结肠癌的发生率为1.07%。结论：对全国住院患者队列的症状模式分析显示了EOCRC的不同临床表现。便秘在年轻人中表现出更强的相关性，尤其是女性，这表明便秘在识别高风险症状方面具有潜在作用。然而，这些发现反映了住院治疗的情况，对于病情较晚期或复杂的患者，而不是早期发现的患者，可能会有丰富的结果。重要的是，尽管存在显著的相关关联，但结直肠癌在便秘相关住院患者中的绝对患病率仍然很低，这强调了谨慎解释和进一步前瞻性验证的必要性。摘要：在这项无结构、症状驱动的全国性分析中，便秘与早发性结直肠癌（EOCRC）的相关性明显高于与晚发性疾病的相关性。这些发现表明，数据驱动的症状评估可以揭示临床相关信号，为早期识别和诊断EOCRC提供信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer treatment and research communications Medicine-Oncology

CiteScore

4.30

自引率

0.00%

发文量

148

审稿时长

56 days

期刊介绍： Cancer Treatment and Research Communications is an international peer-reviewed publication dedicated to providing comprehensive basic, translational, and clinical oncology research. The journal is devoted to articles on detection, diagnosis, prevention, policy, and treatment of cancer and provides a global forum for the nurturing and development of future generations of oncology scientists. Cancer Treatment and Research Communications publishes comprehensive reviews and original studies describing various aspects of basic through clinical research of all tumor types. The journal also accepts clinical studies in oncology, with an emphasis on prospective early phase clinical trials. Specific areas of interest include basic, translational, and clinical research and mechanistic approaches; cancer biology; molecular carcinogenesis; genetics and genomics; stem cell and developmental biology; immunology; molecular and cellular oncology; systems biology; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; cancer policy; and integration of various approaches. Our mission is to be the premier source of relevant information through promoting excellence in research and facilitating the timely translation of that science to health care and clinical practice.