Nonoperative Management in Patients With Early-Onset Rectal Adenocarcinoma: A Retrospective Cohort Study

The incidence of rectal adenocarcinoma is rising in patients < 50 years old compared to those > 50. Nonoperative management and active surveillance have become a standard of care in rectal cancer treatment for those who achieve a complete response to neoadjuvant therapy; however, the use, safety and efficacy of this approach in different age groups has not been well described.

Examine oncological outcomes in patients with rectal adenocarcinoma managed by nonoperative management according to patient age.

Retrospective cohort study.

Comprehensive cancer center in New York.

Patients with rectal adenocarcinoma diagnosed between January 2006 and December 2020.

Local regrowth, recurrence-free survival, distant metastasis-free survival, overall survival rates.

A cohort of 430 patients with rectal adenocarcinoma who were treated with neoadjuvant therapy and entered watch-and-wait were included. Patients were divided into 3 groups according to age at diagnosis: early-onset (age < 50, n = 98), middle-aged (50-64, n = 163), and late-onset (65+, n = 169). No differences were noted in tumor distance from the anal verge (p = 0.345) between groups. More patients in the early-onset cohort received induction chemotherapy with chemoradiation than late-onset patients, who more often received chemoradiation alone and had clinical stage I disease (p = 0.015). Median follow-up time was 4.0years (IQR 2.6-5.5). The 3-year local regrowth rates in each group were 23.8% (95% CI: 15.2-32.4), 33.0% (95% CI: 25.6-40.4), and 26.1% (95% CI: 19.4-32.8) in the early, middle-aged, and late-onset patients, respectively (p = 0.395). No associated differences in 5-year distant metastasis-free or recurrence-free survival rates were noted between the 3 age groups. The early-onset cohort had an associated superior disease-specific survival from the late-onset cohort.

Retrospective nature.

Early-onset rectal cancer patients have at least similar oncological outcomes compared to those in older age groups when treated non-operatively. These data provide reassurance when offering a watch-and-wait approach to patients with early-onset rectal cancer. See Video Abstract.