Related Experiment Video
Updated: Feb 28, 2026
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Clinical characteristics and outcomes in patients with early-onset locally advanced rectal cancer
Andrea Pretta1, Riccardo Giampieri2, Pina Ziranu3
1Medical Oncology Unit, University Hospital and University of Cagliari, SS554 km 4,500 bivio per Sestu, Monserrato, Cagliari 09042, Italy.
Background:
The incidence of early-onset colorectal cancer (EO-CRC), defined as a diagnosis before 50 years of age, is increasing worldwide. However, its clinical characteristics and outcomes compared to average-onset colorectal cancer (AO-CRC) remain under debate, especially in the setting of locally advanced rectal cancer (LARC).
Objectives:
This study aimed to compare clinical characteristics, treatment responses, and survival outcomes between patients with early-onset and average-onset locally advanced rectal cancer.
Design:
A multicenter retrospective cohort study.
Methods:
We retrospectively analysed 305 patients with stage II-III rectal cancer treated between 2012 and 2022 across three Italian oncology centrers. Patients were categorised as EO-RC (⩽50 years) or AO-RC (>50 years). All patients underwent neoadjuvant chemoradiotherapy followed by total mesorectal excision. Pathological and radiological responses were evaluated, and survival outcomes were assessed through Kaplan-Meier methods.
Results:
Early-onset patients accounted for 10.5% of the cohort. Clinical and pathological characteristics were broadly similar between groups, although EO-RC patients had a higher prevalence of proficient mismatch repair status. Radiological and pathological response rates were comparable. After a median follow-up of 120 months, the 10-year overall survival (OS) was 73.3% in EO-RC and 91.9% in AO-RC (HR 7.60, 95% CI 2.22-26.06; p = 0.0012). Disease-free survival (DFS) at 10 years was 57.1% in EO-RC and 70.9% in AO-RC (HR 1.80, 95% CI 0.86-3.78; p = 0.1177).
Conclusion:
Early-onset rectal cancer patients exhibit similar response rates and DFS compared to older patients, but appear to have worse OS. Further studies are needed to explore biological factors and post-recurrence treatment strategies that may influence these outcomes.
