Early Onset Colorectal Cancer in Arabs, Are We Dealing with a Distinct Disease?

SIMPLE SUMMARY: The recent alarming increase in EOCRC incidence globally calls for research to understand the disease and its epidemiology from different geographical regions. Therefore, experts call for the inclusion of CRC patients from different geographical regions to understand the clinicopathological and molecular features of the disease. Our study is among the very few studies that evaluate the epidemiology and clinicopathological signatures and survival of EOCRC in the Arab population. Despite the reported significant difference in stage, molecular signature, and survival of EOCRC compared to LOCRC, our study showed no differences between the two groups. This could be explained either by a unique entity of the EOCRC in Arabs or the absence of a screening program for those above 50 years old. ABSTRACT: Early-onset colorectal cancer (EOCRC) incidence is increasing worldwide. Efforts are directed to understand the biological and clinical signatures of EOCRC compared to late-onset colorectal cancer (LOCRC). EOCRC is thought to present differently across different ethnic groups and geographical regions. This study was an attempt to contribute with data from the Arab world toward the understanding of the clinicopathological parameters of EOCRC compared to LOCRC. Data from 254 CRC patients diagnosed at Sultan Qaboos University Hospital from the period 2015–2020 were studied. About 32.6% of all diagnosed CRC patients are below 50 years old, with no differences in gender distribution between EOCRC and LOCRC (p-value 0.417). Rectal involvement and tumor laterality were comparable among the two groups. Adenocarcinoma accounts for 83.3% and 94.2% of EOCRC and LOCRC, respectively. More mucinous and signet ring adenocarcinoma (8.3% each) were reported in EOCRC than LOCRC (2.9% and 2.2%, respectively). MLH1 and PMS2 loss are more common among LOCRC, but MSH6 loss is more frequent in EOCRC. The overall survival of EOCRC and LOCRC was comparable (median survival 64.88 and 67.24 months, respectively). This study showed comparable clinicopathological parameters between EOCRC and LOCRC from Arabs, which adds to the bigger picture of understand the disease.