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. Author manuscript; available in PMC: 2024 Jun 26.
Published in final edited form as: Clin Gastroenterol Hepatol. 2022 Dec 20;21(3):581–603.e33. doi: 10.1016/j.cgh.2022.12.006

Table 3.

Statements Pertaining to the Pathology and Oncological Treatment (O) of Early-Onset Colorectal Cancer

Question and statement Level of evidence, grade of recommendation, agreement level, and clarity

Pathology and oncological treatment of early-onset colorectal cancer (O)
 O.1: Is it necessary to test tumors for mismatch repair deficiency with immunohistochemistry or microsatellite instability analysis?
   All CRCs should undergo evaluation for mismatch repair (MMR) phenotype (with either immunohistochemistry staining for MMR proteins or microsatellite instability testing) preferably in the pretreatment setting on biopsies when feasible.
LE 1B; GR A
Agreement: 100% (A+ 92.6%|A 7.4%)
 O.2: Which molecular markers are necessary for targeted treatments in eoCRC?
   Molecular profiling should not be different in eoCRC compared with CRC in older patients, and it should include testing for DNA mismatch repair phenotype/MSI, KRAS, NRAS, BRAF, Her2, and NTRK.
LE 2B; GR C
Agreement: 96.3% (A+ 88.9%|A 7.4%|D− 3.7%)
 O.3: What is the adjuvant postoperative treatment in eoCRCs?
   There is no evidence that adjuvant therapy in resected colorectal cancer (stage II at high risk and stage III) should differ between eoCRC patients and patients older than 50 years.
LE 1B; GR B
Agreement: 97.1% (A+ 37.1%|A 60.0%|D− 2.9%)
 O.4: What is the role of neoadjuvant and systemic treatment in rectal and colon eoCRC?
   A. There is no evidence that neoadjuvant therapy in locally advanced rectal cancer should differ between eoRC patients and patients older than 50 years.
   B. There is no evidence that systemic therapy should differ between eoCRC patients and patients older than 50 years.
LE 1B; GR B
Agreement: 93.3% (A+ 40.0%|A 53.3%|A− 6.7%)
LE 1B; GR B
Agreement: 93.5% (A+ 35.5%|A 58.1%|A− 6.5%)