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Survival favorable among younger patients with rectal cancer despite having advanced disease
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Younger patients with rectal cancer have comparable survival outcomes as middle-aged patients despite more frequently presenting with advanced disease and unfavorable tumor characteristics, according to results of a population-based study conducted in the Netherlands.
The study data also demonstrated a positive correlation between survival and adjuvant chemotherapy, even though its use is considered controversial.
“Our results suggest that young patients do not fare worse than older patients and therefore should be equally treated,” Harm J. T. Rutten, MD, PhD, FRCS, an oncologist in the department of surgery at Catharina Hospital in Eindhoven, The Netherlands, and colleagues wrote. “Studies should focus more on age and biological tumor behavior and the effect of treatment on these characteristics.”
Rutten and colleagues sought to investigate the differences in tumor stage, morphology, treatment and survival between young patients (aged 40 years and younger) and middle-aged patients (aged 41 to 70 years). Secondarily, the investigators evaluated the influence of adjuvant chemotherapy on survival among younger patients.
The researchers retrospectively analyzed data from 37,056 patients who were diagnosed with rectal cancer in The Netherlands between 1989 and 2010 using the Netherlands Cancer Registry. Overall, 3% of the patients (n = 1,102) were aged 40 years or younger.
Compared with the middle-aged patients, a greater proportion of the younger population presented with stage III disease (27.8% vs. 33.8%; P < .001) and stage IV disease (24.3% vs. 19.6%; P < .001).
Additionally, younger patients more frequently had mucinous tumors (10.8% vs. 9%), signet cell carcinomas (2.6% vs. 0.6%) and poorly differentiated tumors (16.6% vs. 12.3%; P = .001 for all) than the middle-aged cohort.
The use of neo-adjuvant radiotherapy and chemoradiation appeared comparable between the cohorts. However, a smaller proportion of younger patients underwent surgery (85.9% vs. 88.5%; P = .008) and a greater proportion received adjuvant chemotherapy (23.6% vs. 14.3%; P ˂ .001) than older patients. When researchers only evaluated patients with local disease (stage I-III) an equal proportion of younger or middle-aged patients underwent surgery (97.4% vs. 97.1%).
Younger age appeared prognostic for better outcomes among patients with stage I to stage III rectal cancer (relative excess risk [RER] = 0.82; 95% CI, 0.71-0.94). However, this association did not persist among patients with stage IV disease (RER = 1.04; 95% CI, 0.91-1.18).
Adjuvant chemotherapy improved survival for patients with stage I to stage III rectal cancer (RER = 0.76; 95% CI, 0.70-0.83).
“It is possible that the observed differences in tumor morphology between the age groups represent different biological behavior, rendering these tumors more susceptible to adjuvant chemotherapy,” Rutten and colleagues wrote. “Ultimately our results should stimulate further research about adjuvant chemotherapy in rectal cancer with a focus on patient age and/or biological tumor behavior, rather than changing the current national guidelines for rectal cancer.” – by Anthony SanFilippo
Disclosure: The researchers report no relevant financial disclosures.
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