BACKGROUND: The incidence of rectal cancer in young Indians is increasing. Recent evidence suggests a probable existence of noncanonical tumorigenesis pathways in early-onset colorectal cancer patients in India. The aim of the study was to evaluate rectal cancer outcomes in patients ≤40 years with those >40 years. METHODS: An analysis of a prospective database of surgically treated rectal cancer patients ≤40 years (group 1) and those >40 years (group 2) over 2 years was performed. Clinicopathological features, perioperative outcomes, and disease-free survival (DFS) were analyzed. RESULTS: Of the 512 patients with colorectal cancer treated surgically, 237 patients (group 1-57 patients; group 2-180 patients) were diagnosed with nonmetastatic rectal adenocarcinoma. Patients in group 1 were more likely to present with locally advanced (stage III) disease (p < 0.005) resulting in a higher proportion of them receiving neoadjuvant chemoradiotherapy (NACT-RT). There was no difference in morbidity and mortality between the two groups. Younger patients had a significantly higher median total and positive lymph node yield (p < 0.003). Patients in group 1 had a significantly lower overall DFS (p < 0.005). Stage-specific DFS also demonstrated a significantly lower trend in stage III patients in group 1. CONCLUSIONS: Young rectal cancer patients in India tended to present more frequently with locally advanced tumors resulting in a higher proportion being treated with NACT-RT. Stapled rectal anastomoses could be performed safely in young patients even after NACT-RT. The significantly poorer DFS in young Indian patients with stage III disease was a novel finding and merits further investigation into tumor biology.
BACKGROUND: The incidence of rectal cancer in young Indians is increasing. Recent evidence suggests a probable existence of noncanonical tumorigenesis pathways in early-onset colorectal cancerpatients in India. The aim of the study was to evaluate rectal cancer outcomes in patients ≤40 years with those >40 years. METHODS: An analysis of a prospective database of surgically treated rectal cancerpatients ≤40 years (group 1) and those >40 years (group 2) over 2 years was performed. Clinicopathological features, perioperative outcomes, and disease-free survival (DFS) were analyzed. RESULTS: Of the 512 patients with colorectal cancer treated surgically, 237 patients (group 1-57 patients; group 2-180 patients) were diagnosed with nonmetastatic rectal adenocarcinoma. Patients in group 1 were more likely to present with locally advanced (stage III) disease (p < 0.005) resulting in a higher proportion of them receiving neoadjuvant chemoradiotherapy (NACT-RT). There was no difference in morbidity and mortality between the two groups. Younger patients had a significantly higher median total and positive lymph node yield (p < 0.003). Patients in group 1 had a significantly lower overall DFS (p < 0.005). Stage-specific DFS also demonstrated a significantly lower trend in stage III patients in group 1. CONCLUSIONS: Young rectal cancerpatients in India tended to present more frequently with locally advanced tumors resulting in a higher proportion being treated with NACT-RT. Stapled rectal anastomoses could be performed safely in young patients even after NACT-RT. The significantly poorer DFS in young Indian patients with stage III disease was a novel finding and merits further investigation into tumor biology.
Authors: P Therasse; S G Arbuck; E A Eisenhauer; J Wanders; R S Kaplan; L Rubinstein; J Verweij; M Van Glabbeke; A T van Oosterom; M C Christian; S G Gwyther Journal: J Natl Cancer Inst Date: 2000-02-02 Impact factor: 13.506
Authors: J C Cusack; G G Giacco; K Cleary; B S Davidson; F Izzo; J Skibber; J Yen; S A Curley Journal: J Am Coll Surg Date: 1996-08 Impact factor: 6.113
Authors: Y Nancy You; Eric J Dozois; Lisa A Boardman; Jeremiah Aakre; Marianne Huebner; David W Larson Journal: Ann Surg Oncol Date: 2011-03-30 Impact factor: 5.344
Authors: Dominique Schell; Shahid Ullah; Mark E Brooke-Smith; Paul Hollington; Marina Yeow; Christos S Karapetis; David I Watson; Stephen J Pandol; Claire T Roberts; Savio G Barreto Journal: Cancers (Basel) Date: 2022-01-06 Impact factor: 6.639