Molecular characteristics of early-onset compared with late-onset colorectal cancer - a case controlled study

Sep 21, 2026

Uploaded by Oliver

Early-onset colorectal cancer (EOCRC) is linked to worse outcomes than late-onset colorectal cancer (LOCRC), with steadily increasing incidence. A case-control study compared the molecular features of 578 EOCRC cases and 10,766 LOCRC cases. Next-generation sequencing assessed tumor mutations and tumor mutation burden (TMB), while immunohistochemistry quantified PD-L1 and capillary electrophoresis determined MSI. EOCRC showed more advanced clinical features, higher MSI-H prevalence, enriched mutations, higher TMB, and increased PD-L1 expression.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Background

Methods

Results

Conclusions

Introduction

’Case-Control Study Molecular characteristics of early-onset compared with late-onset colorectal cancer: a case controlled study Junwei Tanga , Wen Penga , Chuanxing Tiana , Yue Zhanga , Dongjian Jia , Lu Wanga , Kangpeng Jina , Fufeng Wangb , Yang Shaoc , Xiaowei Wanga,*, Yueming Suna,* Background: Early-onset colorectal cancer (EOCRC) is associated with a poorer prognosis relative to late-onset colorectal cancer (LOCRC), and its incidence has witnessed a gradual escalation in recent years. This necessitates a comprehensive examination of the underlying pathogenesis and the identiﬁcation of therapeutic targets speciﬁc to EOCRC patients. The present study aimed to delineate the distinct molecular landscape of EOCRC by juxtaposing it with that of LOCRC. Methods: A total of 11 344 colorectal cancer patients, diagnosed between 2003 and 2022, were enrolled in this study, comprising 578 EOCRC cases and 10 766 LOCRC cases. Next-generation sequencing technology was employed to assess the tumor-related mutation and tumor mutation burden (TMB) in these patients. PD-L1 expression was quantiﬁed using immunohistochemistry. Microsatellite instability (MSI) was determined via capillary electrophoresis (2B3D NCI Panel) . Results: Upon comparing LOCRC with EOCRC patients, the latter group demonstrated a tendency towards advanced TNM stage, lower tumor differentiation, and less favorable histological types. Among LOCRC patients, those with MSI-H status were found to have an earlier TNM stage compared to those with MSI-L/MSS status. Signiﬁcantly, the incidence of MSI-H was notably higher in EOCRC (10 .2%) compared to LOCRC (2 .2%) . Mutations in the 7-gene panel (ARID1A, FANCI, CASP8, DGFRA, DPYD, TSHR, and PRKCI) were more prevalent in LOCRC. Within the EOCRC cohort, patients with the MSI-H subtype displayed an earlier TNM stage but concurrently exhibited poorer tissue differentiation and a higher frequency of mucinous adenocarcinoma. Among EOCRC patients, FBXW7, FAT1, ATM, ARID1A, and KMT2B mutations were signiﬁcantly enriched in the MSI-H subgroup. A comparative analysis of MSI-H patients revealed heightened mutation frequencies of FGFBR2, PBRM1, RNF43, LRP1B, FBXW7, ATM, and ARID1A in the EOCRC group. Furthermore, EOCRC patients demonstrated a higher overall TMB, particularly in the MSI-H subtype. PD-L1 expression was elevated in EOCRC and positively associated with MSI status. Conclusions: This study revealed a signiﬁcantly higher MSI-H distribution rate in EOCRC, and EOCRC exhibits a distinct mutational signature coupled with higher PD-L1 expression. These ﬁndings hold promise in guiding personalized therapeutic strategies for improved disease management in EOCRC patients. Keywords: Early-onset colorectal cancer, Mismatch repair deﬁciency, Molecular characteristics, PD-1, Sequencing Introduction Colorectal cancer (CRC) remains a signiﬁcant global health challenge, with its treatment landscape continually evolving to address the diverse molecular and clinical features associated with the disease[1,2] . Advances in therapeutic strategies, especially in the realm of immunotherapy, have reshaped the prognosis and management of CRC[3,4] . The development of immune checkpoint inhibitors targeting programmed cell death protein 1 aDepartment of General Surgery, The First Afﬁliated Hospital of Nanjing Medical University, Colorectal Institute of Nanjing Medical University, Jiangsu Province Engineering Research Center of Colorectal Cancer Precision Medicine and Translational Medicine, bNanjing Geneseeq Technology Inc., School of Public Health, Nanjing Medical University and cNanjing Geneseeq Technology Inc., Nanjing, Jiangsu, China J.T., W.P. and C.T. contributed equally to this work. Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. *Corresponding author. Address: Department of General Surgery, Colorectal Institute of Nanjing Medical University, The First Afﬁlia

FAQs

What is the main objective of this study?

To delineate the distinct molecular landscape of early-onset colorectal cancer by comparing it with late-onset colorectal cancer, aiming to support identification of relevant pathogenic mechanisms and therapeutic targets.

How were mutations and tumor mutation burden (TMB) measured?

Next-generation sequencing was used to assess tumor-related mutations and tumor mutation burden in colorectal cancer patients.

What molecular differences were observed between EOCRC and LOCRC?

EOCRC showed a higher MSI-H distribution rate and elevated PD-L1 expression, along with distinct mutational patterns, including enriched mutations in an MSI-H subgroup and higher overall TMB, particularly in MSI-H.

Sep 21, 2026

Uploaded by Oliver

Molecular characteristics of early-onset compared with late-onset colorectal cancer - a case controlled study_Page 1

Open in WPS to view all 12 pages