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. 2018 Sep 1;124(17):3510-3519.
doi: 10.1002/cncr.31527. Epub 2018 Jul 9.

Rectal cancer patients younger than 50 years lack a survival benefit from NCCN guideline-directed treatment for stage II and III disease

Andrew Kolarich  1 , Thomas J George Jr  2 , Steven J Hughes  3 , Daniel Delitto  3 , Carmen J Allegra  2 , William A Hall  4 , George J Chang  5   6 , Sanda A Tan  3 , Christiana M Shaw  3 , Atif Iqbal  3
Affiliations

Rectal cancer patients younger than 50 years lack a survival benefit from NCCN guideline-directed treatment for stage II and III disease

Andrew Kolarich et al. Cancer. .

Abstract

Background: The incidence of rectal cancer in patients younger than 50 years is increasing. To test the hypothesis that the biology in this younger cohort may differ, this study compared survival patterns, stratifying patients according to National Comprehensive Cancer Network (NCCN) guideline-driven care and age.

Methods: The National Cancer Data Base was queried for patients treated with curative-intent transabdominal resections with negative surgical margins for stage I to III rectal cancer between 2004 and 2014. Outcomes and overall survival for patients younger than 50 years and patients 50 years old or older were compared by subgroups based on NCCN guideline-driven care.

Results: A total of 43,106 patients were analyzed. Younger patients were more likely to be female and minorities, to be diagnosed at a higher stage, and to have travelled further to be treated at academic/integrated centers. Short- and long-term outcomes were significantly better for patients younger than 50 years, with age-specific survival rates calculated. Younger patients were more likely to receive radiation treatment outside NCCN guidelines for stage I disease. In younger patients, the administration of neoadjuvant chemoradiation for stage II and III disease was not associated with an overall survival benefit.

Conclusions: Age-specific survival data for patients with rectal cancer treated with curative intent do not support an overall survival benefit from NCCN guideline-driven therapy for stage II and III patients younger than 50 years. These data suggest that early-onset disease may differ biologically and in its response to multimodality therapy.

Keywords: National Cancer Data Base (NCDB); rectal cancer; survival; treatment appropriateness.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES

Thomas J. George reports acting as a consultant for Merck and Bayer for work performed outside of the current study. His institutional research has been supported by Incyte, Bristol-Myers Squibb, Bayer, Merck, NewLink, AstraZeneca/Med-Immune, and Tesaro.

Figures

Figure 1.
Figure 1.
Inclusion criteria algorithm. Ca indicates carcinoma.
Figure 2.
Figure 2.
Concordance of clinical and pathologic stages stratified by age and stage. No difference was noted across age cohorts; this signified equivalent accuracy of clinical staging across groups.
Figure 3.
Figure 3.
Overall survival by age.
Figure 4.
Figure 4.
Overall and relative survival with stage I disease stratified by age and treatment adherence to NCCN guidelines. A survival benefit was noted from following NCCN guideline–driven care in both age cohorts. NCCN indicates National Comprehensive Cancer Network.
Figure 5.
Figure 5.
Overall and relative survival with clinical stage II and III disease stratified by age and chemoradiation therapy: Unlike their older counterparts, patients younger than 50 years showed no survival benefit from NCCN guideline–directed therapy. NCCN indicates National Comprehensive Cancer Network.
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