Comparable survival for young rectal cancer patients, despite unfavourable morphology and more advanced-stage disease

Eur J Cancer. 2015 Sep;51(13):1675-82. doi: 10.1016/j.ejca.2015.06.005. Epub 2015 Jul 6.

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.

Keywords: Adjuvant chemotherapy; Morphology; Rectal cancer; Stage; Survival; Treatment; Young patients.

Publication types

  • Comparative Study

MeSH terms

  • Adenocarcinoma, Mucinous / mortality
  • Adenocarcinoma, Mucinous / pathology
  • Adenocarcinoma, Mucinous / therapy*
  • Adult
  • Age Factors
  • Aged
  • Carcinoma, Signet Ring Cell / mortality
  • Carcinoma, Signet Ring Cell / pathology
  • Carcinoma, Signet Ring Cell / therapy*
  • Cell Differentiation
  • Chemotherapy, Adjuvant
  • Chi-Square Distribution
  • Disease-Free Survival
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Staging
  • Netherlands / epidemiology
  • Rectal Neoplasms / mortality
  • Rectal Neoplasms / pathology
  • Rectal Neoplasms / therapy*
  • Registries
  • Risk Factors
  • Survival Analysis
  • Survival Rate
  • Time Factors
  • Treatment Outcome