National Trends in Rectal Cancer Among Younger Patients: A National Cancer Database Analysis

Area of Science:

• Oncology
• Epidemiology
• Public Health

Background:

• Rectal cancer incidence is increasing in patients under 50.
• Younger patients are diagnosed with more advanced disease.
• Previous studies suggest better survival rates for younger patients, contrary to current observations.

Purpose of the Study:

• To investigate clinical and pathological trends in younger rectal cancer patients.
• To compare trends between younger (<50 years) and older (≥50 years) patient cohorts.
• To analyze survival outcomes based on age, stage, and tumor grade.

Main Methods:

• Retrospective cohort study using the National Cancer Database (NCDB) from 2004-2021.
• Joinpoint regression analysis to assess temporal trends in rectal cancer incidence.
• Chi-square and Kaplan-Meier analyses to compare clinical stage, grade, and overall survival between age groups.

Main Results:

• Rectal cancer rates increased in both younger (5.4% annually) and older (4.2% annually) groups, with a faster rise in younger patients.
• Younger patients were more likely to have advanced stage (III/IV) and higher-grade tumors (p < 0.001).
• Younger patients with advanced disease showed worse median survival (-0.129 years, p=0.016), while survival was similar at earlier stages (p=0.900). Higher-grade tumors correlated with better survival (median difference: -1.071 years, p < 0.001).

Conclusions:

• Rising rectal cancer incidence in young adults is associated with advanced stage at diagnosis and worse outcomes.
• Delayed diagnosis and treatment likely contribute to poorer outcomes in younger patients.
• Enhanced awareness and targeted screening strategies are essential for early detection and improved survival in young rectal cancer patients.