Young onset rectal cancer: a therapeutic challenge

Abstract

Introduction: Prevalence of rectal cancer among the young (patients less than 40 years of age) is on the rise according to recent publications. It is uncertain if the young‐onset rectal cancers have different biology, if they have a different clinical presentation or if they respond differently to treatment. Studies addressing these questions have come up with conflicting results. Our study aimed to compare young‐onset rectal cancer patients to the older ones in terms of tumour characteristics, response to treatment, and survival, among 228 rectal cancer patients seen over a period of 5 years in a tertiary teaching hospital of India. Methods: A total of 246 patients with newly diagnosed rectal cancer registered between January 1, 2014 and December 31, 2018 were included in the study. Patient data obtained from the hospital records were analysed retrospectively. Patients were divided into two groups comprising of young (< 40years) and older patients (> 40years). Both these groups were compared with respect to tumour characteristics, response to treatment, and survival. Of 246 patients, 43 (17.5%) were lost to follow up, therefore data of 203 patients were included for survival analysis. OS and DFS were measured using the Kaplan‐Meier method and were compared using the log‐rank test. Univariate and multivariate analyses were performed using the Cox proportional hazard model. Statistical analysis was performed with SPSS version 23. Results: Young‐onset rectal cancer patients (62%) were characterised by advanced stage at diagnosis, node‐positive disease, and poorer histology. Younger patients were likelier to receive neoadjuvant treatment, and responded significantly better to neoadjuvant chemoradiation in terms of pathological downstaging ( 85.2 vs 74.2%, P< .05) and pathological complete response ( 17% vs 10.8%, P< .05). R0 resection rates were not significantly different among the two groups. In younger patients the 3‐year DFS and 3‐year OS were poorer than their older counterparts, approaching significance. On stratified stage‐wise analysis, for stage III younger patients both 3‐year DFS ( 62% vs 76.3%,