Clinical and Demographic Analysis of Patients with Colorectal Cancer Screened at a Reference Hospital in Southern Brazil: Comparative Study Based on age (Retrospective Cohort Study)

Clinical and Demographic Analysis of Patients with Colorectal Cancer Screened at a Reference Hospital in Southern Brazil: Comparative Study Based on age (Retrospective Cohort Study) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical and Demographic Analysis of Patients with Colorectal Cancer Screened at a Reference Hospital in Southern Brazil: Comparative Study Based on age (Retrospective Cohort Study) Otavio de Carvalho Modaffar Al-Alam, Rafael Jose Vargas Alves, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5026737/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Feb, 2025 Read the published version in BMC Gastroenterology → Version 1 posted 4 You are reading this latest preprint version Abstract Background : Colorectal cancer (CRC) is a prevalent and lethal malignancy. This study examines differences in clinical and prognostic characteristics of CRC between patients under 50 years and those aged 50 and above, treated at a reference hospital in Southern Brazil. Methods : A retrospective cohort study was conducted, analyzing data from the Cancer Hospital Registry in Porto Alegre, RS. Patients diagnosed with colon or rectal adenocarcinoma between January 2013 and December 2017 were included. Variables analyzed included family history, alcoholism, smoking status, clinical staging, tumor laterality, clinical presentation, CEA levels at diagnosis, adjuvant chemotherapy, and neutrophil-to-lymphocyte ratio. Results : The study cohort included 1,121 patients, with 85% aged 50 years or older, and 15% younger than 50 years. Significant differences were observed in smoking status and clinical presentation, with younger patients presenting more aggressive disease characteristics. Conclusions : Age and lifestyle factors, particularly smoking, significantly influenced the clinical presentation and management of colorectal cancer. These findings underscore the importance of targeted prevention strategies and personalized treatment approaches for younger CRC patients. Colorectal cancer Epidemiology Clinical characteristics Age differences Retrospective cohort study Southern Brazil Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Colorectal cancer (CRC) ranks among the most prevalent and lethal neoplasms globally, being the third most common cancer in both sexes in the United States of America and many other parts of the world 1 – 3 . Understanding the characteristics of CRC is crucial for effective prevention and early treatment. Numerous risk factors, including genetic, environmental, and lifestyle factors, influence the development of CRC. Greater knowledge about modifiable risk factors is essential for public awareness and lifestyle changes that can aid in CRC prevention 4 – 10 . In recent decades, an alarming increase in CRC incidence among young adults has been documented, particularly in developed countries, prompting discussions on the causes of this epidemiological shift 11 – 17 . Lifestyle changes, such as increased consumption of ultra-processed foods, saturated fats, simple sugars, and sugary drinks, as well as physical inactivity and rising obesity rates, are key factors in this trend 4 – 8 , 10 . Furthermore, younger patients often present more aggressive clinical features compared to older patients, raising concerns about the need for changes in screening policies and public education on lifestyle modifications to prevent CRC. 16 , 17 This study aims to evaluate the differences in clinical and prognostic characteristics of CRC in patients aged under 50 years old compared to those aged 50 years old and above at a philanthropic reference hospital in Southern Brazil. Methods Study Design and Setting This retrospective cohort study analyzed clinical and demographic data from the Cancer Hospital Registry (CHR) of a Philanthropic Reference Hospital in Porto Alegre, RS. Patients who were diagnosed with colon or rectal adenocarcinoma between January 2013 and December 2017 were included. Participants Patients diagnosed with colorectal adenocarcinoma confirmed by pathological examination and who had at least one medical appointment at this hospital were included in the study. Those with other histological subtypes were excluded. Data Collection Data were retrieved from medical records and included variables such as family history, alcohol consumption, smoking, clinical staging, tumor laterality, clinical presentation, CEA levels at diagnosis, adjuvant chemotherapy, and neutrophil-to-lymphocyte ratio. Statistical Analysis Results were presented as absolute and relative frequencies, and the neutrophil-to-lymphocyte ratio (NLR) was presented as median and interquartile range (IQR). Normality was assessed using the Kolmogorov- Smirnov (K-S) test. To assess the association between age group and the variables, Chi-Square tests with adjusted standardized residuals and Mann- Whitney tests were applied. The significance level adopted was 0.05, and analyses were performed using the SPSS statistical software (IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.). Ethical Statement The present study utilized anonymized data from the Hospital-Based Cancer Registry (RHC) database, which routinely and systematically collects information on oncology patients treated at the institution. These data are stored to support scientific research, epidemiological monitoring, and the improvement of healthcare services. The study involved only the retrospective analysis of existing data, with no direct interventions with participants, thereby minimizing any risk to the individuals integrity and privacy rights. Ethical approval was obtained from the Research Ethics Committee of Santa Casa de Misericórdia de Porto Alegre (Approval No. 4.488.237, January 4, 2021), and given the retrospective design and use of anonymized data, the requirement for informed consent was waived by the ethics committee. Results The cohort included 1,121 patients, of whom 85% were aged 50 or older and 15% younger than 50. Among patients aged 50 or older, 50.6% were male, while among younger patients, 47.6% were male and 52.4% were female. A statistically significant difference was observed in the smoking status between the two age groups, as we can see in figure 1. Among patients younger than 50 years, 40.4% were active smokers, compared to 16.5% in those aged 50 or older (p < 0.001). Figure 1. Smoking status by age group. Regarding clinical staging among patients aged 50 or older, as shown in figure 2, the stages were distributed as follows: stage I at 5.2%, stage II at 27.5%, stage III at 31.3%, and stage IV at 36.1%. For patients younger than age 50, the distribution was: stage I at 5.4%, stage II at 22.2%, stage III at 28.7%, and stage IV at 43.7%. Figure 2 . Clinical Stage by Age Group. Table 1. Demographic data on CRC patients Variables Total >=50 years < 50 years p Number of patients 1,121 953 (85 %) 168 (15 %) Sex (Male) 562(50.1 %) 482(50.6 %) 80 (47.6 %) 0.533 Ethnic group White 934(92.2 %) 800(92.5 %) 134(90.5 %) 0.516 Black 45 (4.4 %) 37 (4.3 %) 8 (5.4 %) Yellow 4 (0.4 %) 4 (0.5 %) 0 (0 %) Mixed 30 (3 %) 24 (2.8 %) 6 (4.1%) Family History 183(68.8 %) 147(68.7 %) 36(69.2 %) 1.000 Alcoholism Never 234(69.4 %) 198 (68 %) 36 (78.3 %) 0.369 Ex-Alcoholism 48(14.2 %) 43 (14.8 %) 5 (10.9 %) Active Alcoholism 55 (16.3 %) 50 (17.2 %) 5 (10.9 %) Smoking Never 247(43.7 %) 199(43.2 %) 48 (46.2 %) <0.001 Ex-smoker 200(35.4 %) 186(40.3 %) 14 (13.5 %) Active smoker 118(20.9 %) 76 (16.5 %) 42 (40.4 %) Table 1 shows the demographic data of the patients included in the study. It indicates that the majority of patients were aged 50 or older, and there were no significant differences in sex or ethnic group distribution between the age groups. Tumor laterality showed that among patients aged 50 or older, 23.1% had right-sided colon cancer and 76.9% had left-sided colon cancer. Among those under 50 years old, 19.3% had right-sided colon cancer and 80.7% had left-sided colon cancer. The clinical presentation varies by age. Among patients aged 50 or older, 92.1% presented with bleeding, 2.3% presented with obstruction/subocclusion, and 5.6% reported pain. Among patients younger than 50 years, 85.3% presented with bleeding, and 14.7% presented with obstruction/subocclusion. This difference was statistically significant (p =50 years < 50 years p Tumor side 0.324 Right 243 (22.5 %) 211 (23.1 %) 32 (19.3 %) Left 836 (77.5 %) 702 (76.9 %) 134 (80.7%) Clinical presentation <0.001 Bleeding 930 (91.1 %) 802 (92.1 %) 128(85.3 %) Obstruction/ Subooclusion Pain 42 (4.1 %) 49 (4.8 %) 20 (2.3 %) 49 (5.6 %) 22 (14.7 %) 0 (0.0 %) Clinical stage I 45 (5.3 %) 36 (5.2 %) 9 (5.4%) 0.282 II 227 (26.5%) 190 (27.5 %) 37 (22.2 %) III 263 (30.7 %) 215 (31.2 %) 48 (28.7 %) IV 322 (37.6 %) 249 (36.1%) 73 (43.7 %) Base CEA 0.069 >10 311(49.6%) 267(51.35%) 44(41.1%) <10 316(50.4%) 253(48,65%) 63(58.9%) Adjuvant treatment 0.758 Yes 73 (50.3 %) 6 (42.9 %) 67 (51.1 %) No 72 (49.7 %) 8 (57.1 %) 64 (48.9 %) Neutrophil-to- lymphocyte ratio 0.247 ≥ 3.0 396 (50.6 %) 331 (49.7 %) 65 (56,0 %) < 3.0 386 (49.4 %) 335 (50.3 %) 51 (44.0 %) Table 2 summarizes the clinical data of the patients, highlighting the differences in clinical presentation and tumor laterality between the age groups. Baseline CEA levels in patients aged 50 or older showed that 51.3% had values greater than 10, while 48.7% had values less than 10. Among patients younger than 50, 41.1% had values greater than 10, and 58.9% had values less than 10. Regarding adjuvant chemotherapy among patients aged 50 or older, 40% received treatment, and 53.3% did not. Among patients younger than 50, 51.1% were treated with adjuvant chemotherapy, while 48.9% were not. The neutrophil-to-lymphocyte ratio showed that among patients aged 50 or older, 49.6% had a ratio of 3 or higher, while 50.4% had a ratio of less than 3. Among patients younger than 50 years, 56% had a ratio of 3 or higher, while 49.4% had a ratio of less than 3. This result is shown in Figure 4 . Figure 4. Neutrophil/Lymphocyte Ratio by Age Group Discussion This study evaluated the influence of multiple variables, including age, sex, race, smoking status, alcoholism, clinical staging, tumor laterality, clinical presentation, CEA levels, adjuvant chemotherapy, and the neutrophil-to- lymphocyte ratio in 1,121 patients diagnosed with colorectal cancer. The analyses revealed significant statistical differences, especially concerning smoking and clinical presentation, providing important insights into the pathogenesis and management of the disease in young patients. Our study showed that a larger portion of young patients (<50 years) are active smokers (40.4%) compared to older patients (16.5%). This finding confirms the information that smoking is a particularly relevant risk factor for the early development of colorectal cancer. This aligns with the literature indicating smoking as a significant modifiable risk factor for colorectal carcinogenesis 4 . A significant difference in clinical presentation between age groups was observed. Younger patients had a higher incidence of obstructive or subocclusive disease at diagnosis (14.7%) compared to older patients (2.3%). This difference suggests that the disease presents itself more aggressively in younger patients. Previous studies have also reported similar findings, indicating that younger patients often present with more advanced stages and aggressive forms of colorectal cancer 16,17 . Other variables provided important insights, despite not showing significant differences. The clinical staging distribution showed a slightly higher proportion of younger patients diagnosed at stage IV, similar to findings in previous studies 18 . Additionally, no significant differences were observed in terms of sex, ethnicity, or tumor laterality that would alter current approaches to colorectal cancer 12 . One observed limitation in this study was the significant loss of data, a common challenge in retrospective cohort studies relying on medical records 10 . Additionally, the inability to perform survival analysis, due to many patients not completing diagnosis and following the treatment to an end within the institution, represented another major constraint of this study. Conclusions The results of this study reinforce the importance of considering variables such as age and lifestyle habits, like smoking, in the diagnosis and treatment of colorectal cancer. The increased prevalence of obstructive symptoms in younger patients suggests the need for a differentiated diagnostic approach for this group. Moreover, the findings show that the disease appears to present more aggressively in younger patients, aligning with existing literature. These findings can guide future research to explore personalized treatments and prevention strategies focused on high-risk populations. Additionally, longitudinal studies can be useful in better understanding the disease progression in different population subgroups. Declarations Funding This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contribution O.C.M.A. wrote the entire manuscript and was responsible for creating all the tables and figures included in the article.R.J.V.A. and C.G.B. served as the study's supervisors. They developed the initial research idea and provided technical assistance and guidance throughout the writing process of the manuscript.J.P.C.,A.P.M.S.Y., C.N.C., J.S., J.R.L., V.V.V., T.B.C.W., A.L.F. and L.G.C. contributed by assisting in the collection of data for the study. References Siegel RL, Wagle NS, Cercek A, Smith RA, Jemal A. Colorectal cancer statistics, 2023. CA Cancer J Clin. 2023;73(3):233–54. 10.3322/caac.21772 . Fessler E, Medema JP. Colorectal Cancer Subtypes: Developmental Origin and Microenvironmental Regulation. Trends Cancer. 2016;2(9):505–18. 10.1016/j.trecan.2016.07.008 . Venugopal A, Carethers JM. Epidemiology and biology of early onset colorectal cancer. EXCLI J. 2022;21:162–82. 10.17179/excli2021- . Gong J, Hutter C, Baron JA, Berndt S, Caan B, Campbell PT, Casey G, Chan AT, Cotterchio M, Fuchs CS, Gallinger S, Giovannucci E, Harrison T, Hayes R, Hsu L, Jiao S, Lin Y, Lindor NM, Newcomb P, Pflugeisen B, Phipps AI, Rohan T, Schoen R, Seminara D, Slattery ML, Stelling D, Thomas F, Warnick G, White E, Potter J, Peters U. A pooled analysis of smoking and colorectal cancer: timing of exposure and interactions with environmental factors. Cancer Epidemiol Biomarkers Prev. 2012;21:1974–85. Vieira AR, Abar L, Chan DSM, Vingeliene S, Polemiti E, Stevens C, Greenwood D, Norat T. Foods and beverages and colorectal cancer risk: a systematic review and meta-analysis of cohort studies, an update of the evidence of the WCRF-AICR Continuous Update Project. Ann Oncol. 2017;28:1788–802. Schwingshackl L, Schwedhelm C, Hoffmann G, Knüppel S, Laure Preterre A, Iqbal K, Bechthold A, De Henauw S, Michels N, Devleesschauwer B, Boeing H, Schlesinger S. Food groups and risk of colorectal cancer. Int J Cancer. 2018;142:1748–58. Tabung FK, Liu L, Wang W, Fung TT, Wu K, Smith-Warner SA, Cao Y, Hu FB, Ogino S, Fuchs CS, Giovannucci EL. Association of dietary inflammatory potential with colorectal cancer risk in men and women. JAMA Oncol. 2018;4:366–73. Zheng X, Hur J, Nguyen LH, Liu J, Song M, Wu K, Smith-Warner SA, Ogino S, Willett WC, Chan AT, Giovannucci E, Cao Y. Comprehensive assessment of diet quality and risk of precursors of early-onset colorectal cancer. J Natl Cancer Inst. 2021;113:543–52. 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Diagnosis of colon cancer differs in younger versus older patients despite similar complaints. Isr Med Assoc J. 2013;15:284–7. Saraste D, Järås J, Martling A. Population-based analysis of outcomes with early-age colorectal cancer. Br J Surg. 2020;107:301–9. Scott RB, Rangel LE, Osler TM, Hyman NH. Rectal cancer in patients under the age of 50 years: The delayed diagnosis. Am J Surg. 2016;211:1014–8. Cercek A, Chatila WK, Yaeger R, Walch H, Fernandes GDS, Krishnan A, Palmaira L, Maio A, Kemel Y, Srinivasan P, Bandlamudi C, Salo-Mullen E, Tejada PR, Belanfanti K, Galle J, Joseph V, Segal N, Varghese A, Reidy-Lagunes D, Shia J, Vakiani E, Mondaca S, Mendelsohn R, Lumish MA, Steinruecke F, Kemeny N, Connell L, Ganesh K, Markowitz A, Nash G, Guillem J, Smith JJ, Paty PB, Zhang L, Mandelker D, Birsoy O, Robson M, Offit K, Taylor B, Berger M, Solit D, Weiser M, Saltz LB, Aguilar JG, Schultz N, Diaz LA, Stadler ZK. A comprehensive comparison of early-onset and average-onset colorectal cancers. J Natl Cancer Inst. 2021;113:1683–92. Yeo H, Betel D, Abelson JS, Zheng XE, Yantiss R, Shah MA. Early-onset colorectal cancer is distinct from traditional colorectal cancer. Clin Colorectal Cancer. 2017;16(4):293–e96. Constantinou V, Constantinou C. Focusing on colorectal cancer in young adults (Review). Mol Clin Oncol. 2023;20(1):8. 10.3892/mco.2023.2706 . Akimoto N, Ugai T, Zhong R, Hamada T, Fujiyoshi K, Giannakis M, Wu K, Cao Y, Ng K, Ogino S. Rising incidence of early-onset colorectal cancer - a call to action. Nat Rev Clin Oncol. 2021;18(4):230–43. 10.1038/s41571-020-00445-1 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 18 Feb, 2025 Read the published version in BMC Gastroenterology → Version 1 posted Editorial decision: Revision requested 13 Sep, 2024 Editor assigned by journal 13 Sep, 2024 Submission checks completed at journal 13 Sep, 2024 First submitted to journal 03 Sep, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5026737","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":353672585,"identity":"c2fa0686-6476-4a31-ba34-db72801114ee","order_by":0,"name":"Otavio de Carvalho Modaffar 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group.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5026737/v1/4f2beb3dfb18ea74d07495db.png"},{"id":71350080,"identity":"f5c9c6f0-d7cd-43a8-8640-a6b0cd900b73","added_by":"auto","created_at":"2024-12-13 14:33:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":66734,"visible":true,"origin":"","legend":"\u003cp\u003eClinical Stage by Age Group.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-5026737/v1/873e32253911246aa068d8b9.png"},{"id":71350081,"identity":"15268cf5-4468-46de-8b47-ebbf44993a7f","added_by":"auto","created_at":"2024-12-13 14:33:13","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":61968,"visible":true,"origin":"","legend":"\u003cp\u003eClinical Presentation: Obstruction/Subocclusion by Age Group.\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5026737/v1/9b3c5cd93a8788a8d5dd7750.jpeg"},{"id":71350968,"identity":"b28ac8ed-1834-4e2e-8124-332ee6149078","added_by":"auto","created_at":"2024-12-13 14:41:13","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":51474,"visible":true,"origin":"","legend":"\u003cp\u003eNeutrophil/Lymphocyte Ratio by Age Group\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5026737/v1/bcf22ab731d81041fe0efe42.jpeg"},{"id":77054788,"identity":"60e02b74-8e9a-4f7d-90d5-60c0afb261e1","added_by":"auto","created_at":"2025-02-24 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class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Understanding the characteristics of CRC is crucial for effective prevention and early treatment.\u003c/p\u003e \u003cp\u003eNumerous risk factors, including genetic, environmental, and lifestyle factors, influence the development of CRC. Greater knowledge about modifiable risk factors is essential for public awareness and lifestyle changes that can aid in CRC prevention\u003csup\u003e\u003cspan additionalcitationids=\"CR5 CR6 CR7 CR8 CR9\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. In recent decades, an alarming increase in CRC incidence among young adults has been documented, particularly in developed countries, prompting discussions on the causes of this epidemiological shift\u003csup\u003e\u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15 CR16\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Lifestyle changes, such as increased consumption of ultra-processed foods, saturated fats, simple sugars, and sugary drinks, as well as physical inactivity and rising obesity rates, are key factors in this trend\u003csup\u003e\u003cspan additionalcitationids=\"CR5 CR6 CR7\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFurthermore, younger patients often present more aggressive clinical features compared to older patients, raising concerns about the need for changes in screening policies and public education on lifestyle modifications to prevent CRC.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e This study aims to evaluate the differences in clinical and prognostic characteristics of CRC in patients aged under 50 years old compared to those aged 50 years old and above at a philanthropic reference hospital in Southern Brazil.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective cohort study analyzed clinical and demographic data from the Cancer Hospital Registry (CHR) of a Philanthropic Reference Hospital in Porto Alegre, RS. Patients who were diagnosed with colon or rectal adenocarcinoma between January 2013 and December 2017 were included.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients diagnosed with colorectal adenocarcinoma confirmed by pathological examination and who had at least one medical appointment at this hospital were included in the study. Those with other histological subtypes were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were retrieved from medical records and included variables such as family history, alcohol consumption, smoking, clinical staging, tumor laterality, clinical presentation, CEA levels at diagnosis, adjuvant chemotherapy, and neutrophil-to-lymphocyte ratio.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResults were presented as absolute and relative frequencies, and the neutrophil-to-lymphocyte ratio (NLR) was presented as median and interquartile range (IQR). Normality was assessed using the Kolmogorov- Smirnov (K-S) test. To assess the association between age group and the variables, Chi-Square tests with adjusted standardized residuals and Mann- Whitney tests were applied. The significance level adopted was 0.05, and analyses were performed using the SPSS statistical software (IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study utilized anonymized data from the Hospital-Based Cancer Registry (RHC) database, which routinely and systematically collects information on oncology patients treated at the institution. These data are stored to support scientific research, epidemiological monitoring, and the improvement of healthcare services. The study involved only the retrospective analysis of existing data, with no direct interventions with participants, thereby minimizing any risk to the individuals integrity and privacy rights. Ethical approval was obtained from the Research Ethics Committee of Santa Casa de Miseric\u0026oacute;rdia de Porto Alegre (Approval No. 4.488.237, January 4, 2021), and given the retrospective design and use of anonymized data, the requirement for informed consent was waived by the ethics committee.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe cohort included 1,121 patients, of whom 85% were aged 50 or older and 15% younger than 50. Among patients aged 50 or older, 50.6% were male, while among younger patients, 47.6% were male and 52.4% were female.\u003c/p\u003e\n\u003cp\u003eA statistically significant difference was observed in the smoking status between the two age groups, as we can see in figure 1. Among patients younger than 50 years, 40.4% were active smokers, compared to 16.5% in those aged 50 or older (p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 1.\u003c/strong\u003e Smoking status by age group.\u003c/p\u003e\n\u003cp\u003eRegarding clinical staging among patients aged 50 or older, as shown in figure 2, the stages were distributed as follows: stage I at 5.2%, stage II at 27.5%, stage III at 31.3%, and stage IV at 36.1%. For patients younger than age 50, the distribution was: stage I at 5.4%, stage II at 22.2%, stage III at 28.7%, and stage IV at 43.7%.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 2\u003c/strong\u003e. Clinical Stage by Age Group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eDemographic data on CRC patients\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;=50 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 50 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of patients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e1,121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e953 (85 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e168 (15 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex (Male)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e562(50.1 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e482(50.6 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e80 (47.6 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.533\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnic group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e934(92.2 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e800(92.5 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e134(90.5 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.516\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e45 (4.4 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e37 (4.3 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e8 (5.4 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eYellow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e4 (0.4 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e4 (0.5 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0 (0 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eMixed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e30 (3 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e24 (2.8 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e6 (4.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily History\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e183(68.8 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e147(68.7 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e36(69.2 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcoholism\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e234(69.4 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e198 (68 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e36 (78.3 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.369\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eEx-Alcoholism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e48(14.2 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e43 (14.8 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e5 (10.9 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eActive\u003c/p\u003e\n \u003cp\u003eAlcoholism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e55 (16.3 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e50 (17.2 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e5 (10.9 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e247(43.7 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e199(43.2 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e48 (46.2 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eEx-smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e200(35.4 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e186(40.3 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e14 (13.5 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eActive smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e118(20.9 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e76 (16.5 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e42 (40.4 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 194px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e shows the demographic data of the patients included in the study. It indicates that the majority of patients were aged 50 or older, and there were no significant differences in sex or ethnic group distribution between the age groups.\u003c/p\u003e\n\u003cp\u003eTumor laterality showed that among patients aged 50 or older, 23.1% had right-sided colon cancer and 76.9% had left-sided colon cancer. Among those under 50 years old, 19.3% had right-sided colon cancer and 80.7% had left-sided colon cancer.\u003c/p\u003e\n\u003cp\u003eThe clinical presentation varies by age. Among patients aged 50 or older, 92.1% presented with bleeding, 2.3% presented with obstruction/subocclusion, and 5.6% reported pain. Among patients younger than 50 years, 85.3% presented with bleeding, and 14.7% presented with obstruction/subocclusion. This difference was statistically significant (p \u0026lt; 0.001) and is shown in \u003cstrong\u003eFigure 3.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 3.\u003c/strong\u003e Clinical Presentation: Obstruction/Subocclusion by Age Group\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eClinical Data\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;=50 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 50 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTumor side\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.324\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eRight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e243 (22.5 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e211 (23.1 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e32 (19.3 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e836 (77.5 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e702 (76.9 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e134 (80.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical presentation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eBleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e930 (91.1 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e802 (92.1 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e128(85.3 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eObstruction/ Subooclusion Pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e42 (4.1 %)\u003c/p\u003e\n \u003cp\u003e49 (4.8 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e20 (2.3 %)\u003c/p\u003e\n \u003cp\u003e49 (5.6 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e22 (14.7 %)\u003c/p\u003e\n \u003cp\u003e0 (0.0 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical stage\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e45 (5.3 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e36 (5.2 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.282\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e227 (26.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e190 (27.5 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e37 (22.2 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e263 (30.7 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e215 (31.2 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e48 (28.7 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e322 (37.6 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e249 (36.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e73 (43.7 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBase CEA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026gt;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e311(49.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e267(51.35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e44(41.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026lt;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e316(50.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e253(48,65%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e63(58.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjuvant treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.758\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e73 (50.3 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e6 (42.9 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e67 (51.1 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e72 (49.7 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e8 (57.1 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e64 (48.9 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeutrophil-to- lymphocyte ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.247\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026ge; 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e396 (50.6 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e331 (49.7 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e65 (56,0 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026lt; 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e386 (49.4 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e335 (50.3 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e51 (44.0 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e summarizes the clinical data of the patients, highlighting the differences in clinical presentation and tumor laterality between the age groups.\u003c/p\u003e\n\u003cp\u003eBaseline CEA levels in patients aged 50 or older showed that 51.3% had values greater than 10, while 48.7% had values less than 10. Among patients younger than 50, 41.1% had values greater than 10, and 58.9% had values less than 10.\u003c/p\u003e\n\u003cp\u003eRegarding adjuvant chemotherapy among patients aged 50 or older, 40% received treatment, and 53.3% did not. Among patients younger than 50, 51.1% were treated with adjuvant chemotherapy, while 48.9% were not.\u003c/p\u003e\n\u003cp\u003eThe neutrophil-to-lymphocyte ratio showed that among patients aged 50 or older, 49.6% had a ratio of 3 or higher, while 50.4% had a ratio of less than 3. Among patients younger than 50 years, 56% had a ratio of 3 or higher, while 49.4% had a ratio of less than 3. This result is shown in \u003cstrong\u003eFigure 4\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 4.\u003c/strong\u003e Neutrophil/Lymphocyte Ratio by Age Group\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study evaluated the influence of multiple variables, including age, sex, race, smoking status, alcoholism, clinical staging, tumor laterality, clinical presentation, CEA levels, adjuvant chemotherapy, and the neutrophil-to- lymphocyte ratio in 1,121 patients diagnosed with colorectal cancer. The analyses revealed significant statistical differences, especially concerning smoking and clinical presentation, providing important insights into the pathogenesis and management of the disease in young patients.\u003c/p\u003e\n\u003cp\u003eOur study showed that a larger portion of young patients (\u0026lt;50 years) are active smokers (40.4%) compared to older patients (16.5%). This finding confirms the information that smoking is a particularly relevant risk factor for the early development of colorectal cancer. This aligns with the literature indicating smoking as a significant modifiable risk factor for colorectal carcinogenesis\u003csup\u003e4\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eA significant difference in clinical presentation between age groups was observed. Younger patients had a higher incidence of obstructive or subocclusive disease at diagnosis (14.7%) compared to older patients (2.3%). This difference suggests that the disease presents itself more aggressively in younger patients. Previous studies have also reported similar findings, indicating that younger patients often present with more advanced stages and aggressive forms of colorectal cancer\u003csup\u003e16,17\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eOther variables provided important insights, despite not showing significant differences. The clinical staging distribution showed a slightly higher proportion of younger patients diagnosed at stage IV, similar to findings in previous studies\u003csup\u003e18\u003c/sup\u003e. Additionally, no significant differences were observed in terms of sex, ethnicity, or tumor laterality that would alter current approaches to colorectal cancer\u003csup\u003e12\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eOne observed limitation in this study was the significant loss of data, a common challenge in retrospective cohort studies relying on medical records\u003csup\u003e10\u003c/sup\u003e. Additionally, the inability to perform survival analysis, due to many patients not completing diagnosis and following the treatment to an end within the institution, represented another major constraint of this study.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe results of this study reinforce the importance of considering variables such as age and lifestyle habits, like smoking, in the diagnosis and treatment of colorectal cancer. The increased prevalence of obstructive symptoms in younger patients suggests the need for a differentiated diagnostic approach for this group. Moreover, the findings show that the disease appears to present more aggressively in younger patients, aligning with existing literature. These findings can guide future research to explore personalized treatments and prevention strategies focused on high-risk populations. Additionally, longitudinal studies can be useful in better understanding the disease progression in different population subgroups.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eO.C.M.A. wrote the entire manuscript and was responsible for creating all the tables and figures included in the article.R.J.V.A. and C.G.B. served as the study's supervisors. They developed the initial research idea and provided technical assistance and guidance throughout the writing process of the manuscript.J.P.C.,A.P.M.S.Y., C.N.C., J.S., J.R.L., V.V.V., T.B.C.W., A.L.F. and L.G.C. contributed by assisting in the collection of data for the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSiegel RL, Wagle NS, Cercek A, Smith RA, Jemal A. Colorectal cancer statistics, 2023. CA Cancer J Clin. 2023;73(3):233\u0026ndash;54. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3322/caac.21772\u003c/span\u003e\u003cspan address=\"10.3322/caac.21772\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFessler E, Medema JP. Colorectal Cancer Subtypes: Developmental Origin and Microenvironmental Regulation. 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Nat Rev Clin Oncol. 2021;18(4):230\u0026ndash;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41571-020-00445-1\u003c/span\u003e\u003cspan address=\"10.1038/s41571-020-00445-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Colorectal cancer, Epidemiology, Clinical characteristics, Age differences, Retrospective cohort study, Southern Brazil","lastPublishedDoi":"10.21203/rs.3.rs-5026737/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5026737/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Colorectal cancer (CRC) is a prevalent and lethal malignancy. This study examines differences in clinical and prognostic characteristics of CRC between patients under 50 years and those aged 50 and above, treated at a reference hospital in Southern Brazil.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A retrospective cohort study was conducted, analyzing data from the Cancer Hospital Registry in Porto Alegre, RS. Patients diagnosed with colon or rectal adenocarcinoma between January 2013 and December 2017 were included. Variables analyzed included family history, alcoholism, smoking status, clinical staging, tumor laterality, clinical presentation, CEA levels at diagnosis, adjuvant chemotherapy, and neutrophil-to-lymphocyte ratio.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The study cohort included 1,121 patients, with 85% aged 50 years or older, and 15% younger than 50 years. Significant differences were observed in smoking status and clinical presentation, with younger patients presenting more aggressive disease characteristics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Age and lifestyle factors, particularly smoking, significantly influenced the clinical presentation and management of colorectal cancer. These findings underscore the importance of targeted prevention strategies and personalized treatment approaches for younger CRC patients.\u003c/p\u003e","manuscriptTitle":"Clinical and Demographic Analysis of Patients with Colorectal Cancer Screened at a Reference Hospital in Southern Brazil: Comparative Study Based on age (Retrospective Cohort Study)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-13 14:33:08","doi":"10.21203/rs.3.rs-5026737/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-13T13:27:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-13T07:23:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-09-13T06:51:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2024-09-03T17:42:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"726e3b07-ae49-42c3-9563-d054017a6d33","owner":[],"postedDate":"December 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-24T16:25:16+00:00","versionOfRecord":{"articleIdentity":"rs-5026737","link":"https://doi.org/10.1186/s12876-025-03607-6","journal":{"identity":"bmc-gastroenterology","isVorOnly":false,"title":"BMC Gastroenterology"},"publishedOn":"2025-02-18 15:57:43","publishedOnDateReadable":"February 18th, 2025"},"versionCreatedAt":"2024-12-13 14:33:08","video":"","vorDoi":"10.1186/s12876-025-03607-6","vorDoiUrl":"https://doi.org/10.1186/s12876-025-03607-6","workflowStages":[]},"version":"v1","identity":"rs-5026737","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5026737","identity":"rs-5026737","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}