Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Aug 15, 2024; 16(8): 3496-3506
Published online Aug 15, 2024. doi: 10.4251/wjgo.v16.i8.3496
Serum ferritin and the risk of early-onset colorectal cancer
Adam L Urback, Kylee Martens, Hannah Stowe McMurry, Emerson Y Chen, Caitlin Citti, Anil Sharma, Adel Kardosh, Joseph J Shatzel
Adam L Urback, Division of Internal Medicine, Oregon Health & Science University, Portland, OR 97239, United States
Kylee Martens, Hannah Stowe McMurry, Emerson Y Chen, Adel Kardosh, Joseph J Shatzel, Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, United States
Caitlin Citti, Anil Sharma, Division of Gastroenterology & Hepatology, Oregon Health & Science University, Portland, OR 97239, United States
Author contributions: Urback AL conducted chart review, statistical analysis, helped develop study design, and wrote the original draft; Martens K and McMurry HS helped write subsequent drafts and provided reviewing and editing; Chen EY, Citti C, Sharma A, and Kardosh A provided reviewing, editing, and clinical advice; Shatzel JJ supervised the study, helped design the study, and provided reviewing and editing.
Supported by the Oregon Health & Sciences (OHSU) Institutional Review Board, No. STUDY00026428.
Institutional review board statement: This study was reviewed and approved by the OHSU Institutional Review Board prior to initiation (Approval No. STUDY00026428).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data and was retrospective in nature.
Conflict-of-interest statement: Shatzel JJ is supported by the National Heart, Lung, and Blood Institute/National Institutes of Health (No. R01HL151367); Shatzel JJ reports receiving consulting fees from Aronora Inc.; the remaining authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Adam L Urback, BSc, MD, MSc, Doctor, Division of Internal Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States. urback@ohsu.edu
Received: March 20, 2024
Revised: May 14, 2024
Accepted: June 11, 2024
Published online: August 15, 2024
Processing time: 140 Days and 21.7 Hours
Abstract
BACKGROUND

The incidence of early-onset colorectal cancer (EO-CRC) is rising in the United States, and is often diagnosed at advanced stages. Low serum ferritin is often incidentally discovered in young adults, however, the indication for endoscopy in EO-CRC is unclear.

AIM

To compare serum ferritin between patients with EO-CRC and healthy controls (HCs), and examine the association of serum ferritin in EO-CRC with patient- and disease-specific characteristics.

METHODS

A retrospective study of patients < 50 years with newly-diagnosed EO-CRC was conducted from 1/2013-12/2023. Patients were included if serum ferritin was measured within 2 years prior to 1 year following CRC histologic diagnosis. To supplement the analysis, a cohort of HCs meeting similar inclusion and exclusion criteria were identified for comparison. A sensitivity analysis including only patients with serum ferritin obtained at or before diagnosis was separately performed to minimize risk of confounding.

RESULTS

Among 85 patients identified with EO-CRC (48 females), the median serum ferritin level was 26 ng/mL (range < 1-2759 ng/mL). Compared to HCs (n = 80211), there were a higher proportion of individuals with EO-CRC with serum ferritin < 20 ng/mL (female 65%, male 40%) versus HCs (female 32.1%, male 7.2%) age 29-39 years (P = 0.002 and P < 0.00001, respectively). Stage IV disease was associated with significantly higher serum ferritin compared to less advanced stages (P < 0.001). Serum ferritin obtained before or at the time of diagnosis was lower than levels obtained after diagnosis. Similar findings were confirmed in the sensitivity analysis.

CONCLUSION

Severe iron deficiency may indicate an increased risk of EO-CRC, particularly at earlier stages. Further studies defining the optimal serum ferritin threshold and routine incorporation of serum ferritin in screening algorithms is essential to develop more effective screening strategies for EO-CRC.

Keywords: Early-onset; Young-onset; Colorectal cancer; Age; Ferritin; Iron deficiency

Core Tip: This is a retrospective study that compares serum ferritin between patients with early-onset colorectal cancer (EO-CRC) and healthy controls (HCs), and examines the association of serum ferritin in EO-CRC with patient- and disease-specific characteristics. We found a higher proportion of individuals with EO-CRC with serum ferritin < 20 ng/mL compared to HCs. Lower serum ferritin in patients with EO-CRC was associated with an earlier stage of disease and a younger age among females. These findings suggest that serum ferritin may be a useful marker in patients with localized disease, emphasizing the importance of early and appropriate gastrointestinal screening in patients found to have iron deficiency.