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Peer-reviewedCC BY-NC-ND 4.0BMC Cancer

Early-onset colorectal cancer in Korea: clinical characteristics, treatment patterns, and survival outcomes in a K-CURE nationwide population-based study

  • Kyunghye Bang1
  • Dawoon Jeong2
  • Semie Hong3
  • Hyeon Kang Koh3
  • Ji Hyun Park1
  • Jeong Yun Jang3
  • Kangpyo Kim4,5
5 affiliations
  1. 1Division of Oncology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
  2. 2Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
  3. 3Department of Radiation Oncology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
  4. 4Department of Radiation Oncology, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
  5. 5Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju, Republic of Korea
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Abstract

Background : The incidence of early-onset colorectal cancer (EOCRC) has increased globally, but its clinical characteristics, treatment patterns, and outcomes remain incompletely characterized, particularly in Asian populations. We compared clinical presentation, treatment patterns, and survival outcomes of EOCRC and late-onset colorectal cancer (LOCRC) in Korea.

Methods : Using the nationwide K-CURE database, we identified patients diagnosed with colorectal cancer between 2012 and 2019. EOCRC was defined as colorectal cancer diagnosed before 50 years of age. Clinical characteristics, initial treatment patterns, and survival outcomes were compared between EOCRC and LOCRC. Propensity score matching and multivariable Cox proportional hazards regression analyses were performed.

Results : Among 20,941 patients, 2,044 (9.8%) had EOCRC, and the proportion remained near 10% throughout the study period. Stage distribution and tumor differentiation were comparable between EOCRC and LOCRC. Patients with EOCRC more frequently received multimodality treatment across disease stages. In unadjusted analyses, EOCRC was associated with lower overall mortality (HR, 0.61; 95% CI, 0.56–0.66), cancer-specific mortality (HR, 0.79; 95% CI, 0.72–0.86), and non-cancer mortality (HR, 0.13; 95% CI, 0.09–0.18), with consistent findings in propensity score–matched and multivariable analyses. The mortality difference was greatest in localized disease and remained evident across stages and primary tumor sites. In molecular subgroup analyses, the association between EOCRC and lower mortality was stronger in MSI tumors than in microsatellite-stable tumors, with a significant interaction, whereas no significant interaction was observed according to KRAS mutation status.

Conclusions : EOCRC was not associated with more advanced disease at diagnosis than LOCRC and was associated with lower observed mortality, which should be interpreted in the context of baseline patient characteristics and treatment patterns.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12885-026-16586-y.

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BibTeXRIS
BibTeX
@article{bang2026earlyonset,
  title = {{Early-onset colorectal cancer in Korea: clinical characteristics, treatment patterns, and survival outcomes in a K-CURE nationwide population-based study}},
  author = {Kyunghye Bang and Dawoon Jeong and Semie Hong and Hyeon Kang Koh and Ji Hyun Park and Jeong Yun Jang and Kangpyo Kim},
  journal = {BMC Cancer},
  year = {2026},
  month = jul,
  doi = {10.1186/s12885-026-16586-y},
  url = {https://doi.org/10.1186/s12885-026-16586-y},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Early-onset colorectal cancer in Korea: clinical characteristics, treatment patterns, and survival outcomes in a K-CURE nationwide population-based study
AU  - Kyunghye Bang
AU  - Dawoon Jeong
AU  - Semie Hong
AU  - Hyeon Kang Koh
AU  - Ji Hyun Park
AU  - Jeong Yun Jang
AU  - Kangpyo Kim
PY  - 2026
DA  - 2026/07/30
JO  - BMC Cancer
DO  - 10.1186/s12885-026-16586-y
UR  - https://doi.org/10.1186/s12885-026-16586-y
AB  - Background : The incidence of early-onset colorectal cancer (EOCRC) has increased globally, but its clinical characteristics, treatment patterns, and outcomes remain incompletely characterized, particularly in Asian populations. We compared clinical presentation, treatment patterns, and survival outcomes of EOCRC and late-onset colorectal cancer (LOCRC) in Korea.  Methods : Using the nationwide K-CURE database, we identified patients diagnosed with colorectal cancer between 2012 and 2019. EOCRC was defined as colorectal cancer diagnosed before 50 years of age. Clinical characteristics, initial treatment patterns, and survival outcomes were compared between EOCRC and LOCRC. Propensity score matching and multivariable Cox proportional hazards regression analyses were performed.  Results : Among 20,941 patients, 2,044 (9.8%) had EOCRC, and the proportion remained near 10% throughout the study period. Stage distribution and tumor differentiation were comparable between EOCRC and LOCRC. Patients with EOCRC more frequently received multimodality treatment across disease stages. In unadjusted analyses, EOCRC was associated with lower overall mortality (HR, 0.61; 95% CI, 0.56–0.66), cancer-specific mortality (HR, 0.79; 95% CI, 0.72–0.86), and non-cancer mortality (HR, 0.13; 95% CI, 0.09–0.18), with consistent findings in propensity score–matched and multivariable analyses. The mortality difference was greatest in localized disease and remained evident across stages and primary tumor sites. In molecular subgroup analyses, the association between EOCRC and lower mortality was stronger in MSI tumors than in microsatellite-stable tumors, with a significant interaction, whereas no significant interaction was observed according to KRAS mutation status.  Conclusions : EOCRC was not associated with more advanced disease at diagnosis than LOCRC and was associated with lower observed mortality, which should be interpreted in the context of baseline patient characteristics and treatment patterns.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12885-026-16586-y.
SN  - 1471-2407
ER  -