The Impact of Surgical Resection in Early Onset Colorectal Cancer Patients With Liver Limited Disease
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Recent studies have shown an increased incidence of early-onset CRC (EO-CRC), particularly in advanced stages and with metastatic disease. Our study aimed to evaluate the role of metastasectomies related to the clinical and molecular characteristics of EO-CRC patients with liver metastases compared to average-onset CRC (AO-CRC) patients. Methods We retrospectively collected data from 1123 stage IV colorectal cancers, including 782 with liver metastases, from 5 different Italian institutions. The main objective of the study was to compare the overall survival of liver metastatic EO-CRC and AO-CRC patients who underwent metastasectomy versus those who were not resected. Results Liver resected EO-CRCs patients showed a statistically significant lower mOS than liver resected AO-CRCs (44.0 vs 64.0 months, p < 0.0001 ). mPFS was also statistically significant lower in EO-CRCs (13.0 vs 17.0, p < 0.0001 ). Same outcomes were found in RAS mut subgroup (37.0 vs 52.0 months, p < 0.0001) and in RAS/BRAF wild-type subgroup (50.0 vs 81.0 months, p < 0.0001). EO-CRC patients showed a higher prevalence of TP53 alterations (56.2%) and a lower of APC mutation (29.9%). EO-CRCs presented a higher frequency of ARID1A (4.4%) and CTNNB1 (3.0%) alterations. Conclusion The results indicate a worse overall prognosis for EO-CRC patients undergoing metastasectomy compared to average-onset patients. This outcome appears to occur independently of the molecular status. These observations could have a considerable impact on clinical practice and research. Micro Abstract In a multicenter cohort of 1209 metastatic CRC patients , early-onset colorectal cancer (≤50 years) showed consistently inferior outcomes after liver metastasectomy. Among the 417 resected cases, EO-CRC had markedly shorter OS (44 vs 64 months) and PFS (13 vs 17 months) compared with older patients. This survival gap persisted across RAS-mutated and RAS/BRAF wild-type subgroups, suggesting a distinct and more aggressive EO-CRC phenotype.
Source: Clinical Colorectal Cancer
Authors: Andrea Pretta, Pina Ziranu, Francesca Bergamo, Andrea Bottelli, Federica Marmorino, Mariapaola Masiello, Stefano Mariani, Krisida Cerma, Filippo Ghelardi, Paolo Ciracì, Alessia Lancianese, Valeria Pusceddu, Eleonora Perissinotto, Alberto Giovanni Leone, Ada Taravella, Erika Cimbro, Gianluca Pretta, Riccardo Cerantola, Luca Papini, Clelia Donisi, Gianmarco Ricagno, Raffaele Squitieri, Riccardo Giampieri, Chiara Cremolini, Sara Lonardi, Filippo Pietrantonio, Mario Scartozzi
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,690
Award: G1993633068
OpenAlex ID: W7129448191