Clinicopathological features and oncological outcomes of patients with young‐onset rectal cancer

• Published in: British journal of surgery Vol. 107; no. 5; pp. 606 - 612
• Main Authors: Zaborowski, A. M., Murphy, B., Creavin, B., Rogers, A. C., Kennelly, R., Hanly, A., Martin, S. T., O'Connell, P. R., Sheahan, K., Winter, D. C.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.04.2020; Oxford University Press
• Subjects: Age of Onset; Chemoradiotherapy, Adjuvant; Chemotherapy, Adjuvant; Colorectal cancer; Colorectal Neoplasms, Hereditary Nonpolyposis - pathology; Colorectal Neoplasms, Hereditary Nonpolyposis - surgery; Genetic disorders; Health risk assessment; Humans; Microsatellite Instability; Middle Aged; Neoadjuvant Therapy; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neoplasm Staging; Rectal Neoplasms - genetics; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Retrospective Studies; Risk Factors; Survival Analysis
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.11526

Background The incidence of rectal cancer among adults aged less than 50 years is rising. Survival data are limited and conflicting, and the oncological benefit of standard neoadjuvant and adjuvant therapies is unclear. Methods Disease‐specific outcomes of patients diagnosed with rectal cancer undergoing surgical resection with curative intent between 2006 and 2016 were analysed. Results A total of 797 patients with rectal cancer were identified, of whom 685 had surgery with curative intent. Seventy patients were younger than 50 years and 615 were aged 50 years or more. Clinical stage did not differ between the two age groups. Patients aged less than 50 years were more likely to have microsatellite instability (9 versus 1·6 per cent; P = 0·003) and Lynch syndrome (7 versus 0 per cent; P < 0·001). Younger patients were also more likely to receive neoadjuvant chemoradiotherapy (67 versus 53·3 per cent; P = 0·003) and adjuvant chemotherapy (41 versus 24·2 per cent; P = 0·006). Five‐year overall survival was better in those under 50 years old (80 versus 72 per cent; P = 0·013). The 5‐year disease‐free survival rate was 81 per cent in both age groups (P = 0·711). There were no significant differences in the development of locoregional recurrence or distant metastases. Conclusion Despite accessing more treatment, young patients have disease‐specific outcomes comparable to those of their older counterparts. Antecedentes La incidencia de cáncer de recto entre adultos menores de 50 años está aumentando. Los datos de supervivencia son limitados y contradictorios, y el beneficio oncológico de los tratamientos neoadyuvantes y adyuvantes estándares no está claro. Métodos Se analizaron los resultados específicos relacionados con la enfermedad en pacientes diagnosticados de cáncer de recto operados con intención curativa entre 2006 y 2016. Resultados Se identificaron un total de 797 pacientes con cáncer de recto, de los cuales 685 fueron intervenidos quirúrgicamente con intención curativa. Setenta tenían menos de 50 años y 615 tenían 50 años o más. No hubo diferencias en el estadio clínico entre los dos grupos de edad. Los pacientes menores de 50 años tenían más probabilidades de tener inestabilidad de microsatélites (9% versus 2%, P = 0,003) y síndrome de Lynch (7% versus 0%, P ≤ 0,001). La supervivencia global a los 5 años fue mayor en los pacientes de menos de 50 años (80% y 72%; P = 0,013). La supervivencia libre de enfermedad a los 5 años fue del 81% en ambos grupos de edad (P = 0,711). No hubo diferencias significativas en el desarrollo de recidiva locorregional o metástasis a distancia. Los pacientes más jóvenes tenían más probabilidades de recibir quimiorradioterapia neoadyuvante (67% versus 53%, P = 0,003) y quimioterapia adyuvante (41% versus 24%, P = 0,006). Conclusión A pesar de tener acceso a más tratamientos, los pacientes jóvenes han presentado resultados específicos relacionados con la enfermedad comparables a sus homólogos de mayor edad. A total of 685 patients with rectal cancer who underwent surgery with curative intent were analysed. Seventy were aged under 50 years and 615 were aged 50 years or over. Younger patients displayed short‐ and long‐term disease‐specific survival comparable to that of their older counterparts despite receiving more neoadjuvant and adjuvant therapy. More aggressive treatment, similar survival