Metabolic Risk Factors Associated with Early Onset Colorectal Adenocarcinoma: A Case-Control Study at Kaiser Permanente Southern California
Menée aux Etats-Unis sur la période 2008-2018 auprès de 5 128 témoins et 1 032 patients atteints d'un adénocarcinome colorectal invasif diagnostiqué entre 15 et 49 ans, cette étude analyse l'association entre des anomalies métaboliques (diabète, obésité, hypertension et dyslipidémie) et le développement précoce de la maladie
Background: The incidence of early onset colorectal cancer (eoCRC) diagnosed among individuals under age 50 has been rising. However, risk factors for eoCRC are unclear. We investigated whether metabolic abnormalities are risk factors for eoCRC adenocarcinoma. Methods: Invasive colorectal adenocarcinoma cases diagnosed between ages 15-49 from 2008-2018 at Kaiser Permanente Southern California (KPSC) were identified. Those with a history of inflammatory bowel disease were excluded. Non-cancer controls were selected 5:1 for each case matched by age, sex, and length of membership prior to index date. Data were collected from KSPC's electronic medical records. The exposures of interest included obesity, type 2 diabetes, hypertension, and dyslipidemia, assessed from {greater than or equal to} 1 year prior to eoCRC diagnosis/index date. Conditional logistic regressions were used to evaluate the associations between these metabolic risk factors and risk of eoCRC adenocarcinoma, adjusting for race/ethnicity, smoking, family history, neighborhood socioeconomic status and health care utilization. Results: A total of 1,032 cases and 5,128 controls were included. Risk of colorectal adenocarcinoma was significantly associated with obesity [odds ratio (OR)= 1.41 (95% confidence interval 1.14-1.74)], but not diabetes, hypertension or dyslipidemia. In analysis stratified by tumor location, obesity was significantly associated with risk of colon adenocarcinoma [OR=1.57 (1.18-2.09)] but its association with rectal adenocarcinoma was less clear [OR=1.17 (0.84-1.64)]. No significant interaction was detected between obesity and age ({greater than or equal to}40 vs. <40), and obesity and sex. Conclusion: Obesity was associated with risk for eoCRC adenocarcinoma. Impact: This finding could help inform early-onset colorectal adenocarcinoma screening and prevention recommendations.