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Published on: February 12, 2022
Long-term disease-free survival in young-onset rectal cancer patients surgically treated with curative intent: a
Oddne Fjellstad Johnsen1,2, Rolf Nerem Riis3, Sebastian Meltzer4
1Department of Gastrointestinal Surgery, Akershus University Hospital, Oslo, Norway. Oddne.Fjellstad.Johnsen@ahus.no.
Purpose:
Although colorectal cancer incidence is declining among individuals aged over 50 years, possibly due to screening, young-onset rectal cancer (YORC) in those under 50 years of age is increasing. YORC is often diagnosed at advanced stages, leading to worse outcomes and higher mortality. This study compared short- and long-term clinical, surgical, and pathological outcomes, including survival, between patients with YORC (< 50 years) and older age groups.
Method:
A retrospective single-center study of patients undergoing curative-intent resection for rectal cancer at a Norwegian university hospital from 2014 to 2024. We divided the cohort into three age groups: < 50 (YORC), 50-75, and > 75. Clinical and pathological parameters, surgical complications, and overall and disease-free survival (DFS) were compared using parametric and nonparametric analyses, Kaplan-Meier methods, and Cox proportional hazard regression.
Results:
642 patients underwent curative-intent surgery for rectal cancer: YORC: n = 53 (8%); 50-75: n = 435 (68%); and > 75: n = 154 (24%). The mean age for YORC was 44 years (range 26-49). The median follow-up was 52.4 months, with an interquartile range (IQR) of 27.9-85.6 months. The oldest age group had worse DFS during follow-up (p < 0.0001, log-rank test); YORC 7 events (13.5%); 50-75 67 events (16.1%); and > 75 66 (44.9%). DFS was comparable between the YORC and the 50-75 group (p = 0.6, log-rank test). Cox models showed poorer DFS in patients aged > 75 (hazard ratio 3.04, p = 0.009) and in those with higher American Society of Anesthesiologists scores or higher pathological stages.
Conclusion:
The YORC group had DFS outcomes comparable to those of patients aged 50-75 following curative-intent surgery. WHAT DOES THIS PAPER ADD TO THE LITERATURE?: While the incidence of YORC has increased over the past decades, few studies have analyzed survival beyond five years. This study compares YORC patients who were followed for a median of more than five years with groups of older patients with shorter follow-up (56.0 months for those aged 50-75 years, and 39.7 for those aged > 75). The outcomes for YORC patients, including disease-free survival, were comparable to those aged 50-75.
