Dr Wong on Next Steps for Validating the Predictive Utility of Molecular Characteristics in CRC

“One of the things I feel that we can do to better [validate the predictive utility of] molecular characteristics [in CRC] is have multicenter collaboration. [Our study] was limited because we are just 1 institution; although we [enrolled] 2379 patients, which is a good number, it would always be better to have collaborative efforts in and outside of Asia.”

Evelyn Y.T. Wong, MD, of the Division of Medical Oncology at the National Cancer Centre Singapore, discussed the potential use of molecular characteristics to predict survival outcomes in patients with early-onset colorectal cancer (CRC).

During the 2025 ESMO Gastrointestinal Cancers Congress, Wong presented data from a single-center retrospective analysis of survival outcomes and molecular characteristics of patients with early-onset CRC (n = 2379). Results showed that patients with early-onset disease experienced a longer median overall survival (OS) vs those with late-onset disease, at 34.6 months vs 28.8 months, respectively (HR, 0.82; 95% CI, 0.66-1.02; P = .075). Additionally, patients with early-onset disease had a lower rate of APC mutations compared with those with late-onset CRC, at 32.4% vs 42.2%, respectively. There were no significant differences between the 2 groups in terms of KRAS (27.5% vs 31.3%) or BRAF (6.9% vs 4.8%) mutations, or regarding mismatch repair deficiency (4.9% vs 1.9%).

Wong noted that multicenter collaboration is needed in the future to further validate these findings. Although the retrospective study enrolled a significant number of patients, it was still limited by its multicenter design. Accordingly, collaborative efforts are needed within Asia and around the world to further elucidate how disease characteristics affect survival and other outcomes, she added.

Investigators are also interested in exploring the relationship between molecular characteristics of disease and exposure to potential disease-causing factors in early childhood, Wong explained. This type of research cannot be done retrospectively and will require prospective evaluation, she added. Academic centers are already discussing this type of research and multiple groups are beginning to design studies, she said.