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. 2016 Jan;108(1):djv284.
doi: 10.1093/jnci/djv284.

Young Age Increases Risk of Lymph Node Positivity in Early-Stage Rectal Cancer

Joshua E Meyer, Steven J Cohen, Karen J Ruth, Elin R Sigurdson, Michael J Hall

Young Age Increases Risk of Lymph Node Positivity in Early-Stage Rectal Cancer

Joshua E Meyer et al. J Natl Cancer Inst. 2016 Jan.

Abstract

Background: The risk of lymph node positivity (LN+) in rectal cancer is a parameter that impacts therapeutic recommendations. We aimed to quantify the effect of younger age on LN+ in rectal cancer.

Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, patients with rectal cancer diagnosed between 1988 and 2008 were identified. Patients were stage I-III, without preoperative radiotherapy, at least one lymph node examined, and a standard rectal cancer operation performed. The association of age and LN+ status was examined with logistic regression separately for each T stage, adjusting for multiple covariates. Poisson regression was used to evaluate age and number of positive lymph nodes (LNs). All statistical tests were two-sided.

Results: Fifty-six thousand seventy-six patients were identified, including 1194 (2.1%) patients age 20 to 39 years at diagnosis and 4199 (7.5%) patients age 40 to 49 years (defined as young). For each T stage, LN+ was inversely associated with age (all P < .001). For T1, T2, and T3, age remained predictive of LN+ status after adjustment for number of LNs examined and other covariates (P < .001 for each stage). Adjusted odds ratios (ORs) for LN+ for age 20 to 39 vs 60 to 69 were: T1: 1.97(95% confidence interval [CI] = 1.36 to 2.86); T2: 1.48 (95% CI = 1.13 to 1.95); T3: 1.30 (95% CI = 1.10 to 1.53). Young age was a statistically significant predictor of an increased number of LNs positive for stage T2 (P = .042) and T3 (P = .002).

Conclusion: In this large national dataset, young age at diagnosis is associated with an increased risk of LN+. This finding merits further investigation and may ultimately impact treatment decision-making for young early-stage patients.

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Figures

Figure 1.
Figure 1.
Node positivity and age of diagnosis, by T stage and number of lymph nodes examined. LN = lymph node.
See this image and copyright information in PMC

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