Ricardo G Orsini1, Rob H A Verhoeven2, Valery E P P Lemmens3, Liza N van Steenbergen2, Ignace H J T de Hingh1, Grard A P Nieuwenhuijzen1, Harm J T Rutten4. 1. Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands. 2. Netherlands Cancer Registry/Comprehensive Cancer Organisation of the Netherlands, Eindhoven, The Netherlands. 3. Netherlands Cancer Registry/Comprehensive Cancer Organisation of the Netherlands, Eindhoven, The Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands. 4. Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands; Department of Surgery, Maastricht University Medical Center, Maastricht of School for Oncology and Development Biology (GROW), Maastricht, The Netherlands. Electronic address: harm.rutten@catharinaziekenhuis.nl.
Abstract
BACKGROUND: Young patients with rectal cancer tend to present with more advanced-stage disease and unfavourable tumour morphology. The effects of these tumour characteristics on survival in this particular patient group are unclear. METHODS: Population-based data from the Netherlands Cancer Registry (NCR) were used. Data from patients diagnosed with rectal cancer between 1989 and 2010 were selected. Younger patients (⩽ 40 years) were compared with middle-aged patients (41-70 years) with respect to disease stage, tumour characteristics, treatment and outcomes. Patients aged older than 70 years were excluded. Relative excess risk (RER) models were used to perform uni- and multivariate survival analyses. FINDINGS: A total of 37.056 patients were included (⩽ 40 years n = 1.102). Compared with middle-aged patients, young patients were more likely to have stage III (33.8% versus 27.8%) and stage IV (24.3% versus 19.6%) disease (p < 0.001). Young patients also presented more frequently with mucinous tumours (10.8% versus 9.0%), signet cell carcinomas (2.6% versus 0.6%) and poorly differentiated tumours (16.6% versus 12.3%) (p = 0.001). The treatment of stage I-III patients did not differ between the two groups, except regarding adjuvant chemotherapy, which was more often given to young patients (24.3% versus 14.4%, p < 0.001). Young age was a prognostic factor for better survival in stage I-III patients (RER 0.82 CI 0.71-0.94). Adjuvant chemotherapy was associated with improved survival in stage I-III patients (RER 0.76, 95%CI 0.70-0.83). In an exploratory analysis, adjuvant chemotherapy in young stage III and pN1 patients was associated with improved survival. CONCLUDING STATEMENT: Young patients present with more advanced disease and have more unfavourable tumour characteristics compared with middle-aged patients. Despite these characteristics, survival rates are equal, and young age is a prognostic factor for better survival. Although the use of adjuvant chemotherapy is controversial, a positive correlation with survival was found in this study.
BACKGROUND: Young patients with rectal cancer tend to present with more advanced-stage disease and unfavourable tumour morphology. The effects of these tumour characteristics on survival in this particular patient group are unclear. METHODS: Population-based data from the Netherlands Cancer Registry (NCR) were used. Data from patients diagnosed with rectal cancer between 1989 and 2010 were selected. Younger patients (⩽ 40 years) were compared with middle-aged patients (41-70 years) with respect to disease stage, tumour characteristics, treatment and outcomes. Patients aged older than 70 years were excluded. Relative excess risk (RER) models were used to perform uni- and multivariate survival analyses. FINDINGS: A total of 37.056 patients were included (⩽ 40 years n = 1.102). Compared with middle-aged patients, young patients were more likely to have stage III (33.8% versus 27.8%) and stage IV (24.3% versus 19.6%) disease (p < 0.001). Young patients also presented more frequently with mucinous tumours (10.8% versus 9.0%), signet cell carcinomas (2.6% versus 0.6%) and poorly differentiated tumours (16.6% versus 12.3%) (p = 0.001). The treatment of stage I-III patients did not differ between the two groups, except regarding adjuvant chemotherapy, which was more often given to young patients (24.3% versus 14.4%, p < 0.001). Young age was a prognostic factor for better survival in stage I-III patients (RER 0.82 CI 0.71-0.94). Adjuvant chemotherapy was associated with improved survival in stage I-III patients (RER 0.76, 95%CI 0.70-0.83). In an exploratory analysis, adjuvant chemotherapy in young stage III and pN1patients was associated with improved survival. CONCLUDING STATEMENT: Young patients present with more advanced disease and have more unfavourable tumour characteristics compared with middle-aged patients. Despite these characteristics, survival rates are equal, and young age is a prognostic factor for better survival. Although the use of adjuvant chemotherapy is controversial, a positive correlation with survival was found in this study.
Authors: Leonardo Saúl Lino-Silva; Rosa A Salcedo-Hernández; Erika B Ruiz-García; Alberto M León-Takahashi; Leticia García-Pérez Journal: J Gastrointest Oncol Date: 2017-02