Symptom Burden and Time from Symptom Onset to Cancer Diagnosis in Patients with Early-Onset Colorectal Cancer: A Multicenter Retrospective Analysis

Round 1

Reviewer 1 Report

The present study compares the symptom burden, stage of disease at diagnosis and survival in patients diagnosed above or belove the age of 50 years. The manuscript is well written and easy to read.

A total of 27.616 patient diagnosed with CRC in the period from 1990-2017 were included in the study. Of these 2.544 were under the age of 50 and defined as early onset CRC (EoCRC). 

For the retrospective chart analysis all the 2.544 patents with EoCRC were included and a matching control group of late onset (above the age of 50 years) colorectal cancer (LoCRC) diagnosed between January 1 2015- and December 31, 2016 were included. The argument was to ensure maximum availability of hospital records to conduct the analysis and to ensure 5 years of follow up for comparison. I do not understand why. Did you expect that the records from the EoCORC would be more reliable during the early period of inclusion and why.? Could there be any differences in record registration of symptoms over and treatment over time? 

You found a statistically significant different in disease state at the diagnosis, but when you look at the figures only small difference were found. Please comment on this in the discussion. 

The significance of the number of presenting symptoms may be difficult to interpret. The EoCRC patients and physicians may tend to report more symptoms compared to the elderly (LoCRC)? In the figures it should be Numbers of symptoms and not symptom number, which may be confusing. 

Not surprisingly the overall survival for almost all situations were better in EoCRC. What about cancer free survival?

Author Response

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Reviewer 2 Report

Dear Authors,

I have read the manuscript with interesting. It was well planed and executed. I found a little imperfection in  Table 1.

Mucinous cell and signet cell - that type of histopathological cancer description is incorrect. 

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Reviewer 3 Report

The study is well designed. My only concern is that the burden of stastistical data in the various chapters make it difficult to follow at times.

However the subject is interesting and I congratulate you.

Author Response

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Round 2

Reviewer 2 Report

Dear Authors

I acccepted the revised version.