Outcomes of young patients diagnosed with locally advanced rectal cancer

Rosemary Habib^{1

2

3

4}, Nicholas G Burgess^{3

5}, Michael J Bourke^{3

5}, Mark Wong^{2

3

6}, Nicholas Wilcken^{2

3}, James Toh^{3

7}, Toufic El-Khoury^{3

7

8}, Nimalan Pathma-Nathan⁷, Grahame Ctercteko⁷, Jayasingham Jayamohan^{3

9}, Kenneth Micklethwaite^{1

3

4

10}, Adnan Nagrial^{2

3

6}

Affiliations

¹ Westmead Clinical School, The University of Sydney, Sydney, Australia.
² Department of Medical Oncology, Westmead Hospital, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.
³ Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
⁴ The Westmead Institute for Medical Research, Westmead, New South Wales, Australia.
⁵ Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
⁶ Blacktown hospital, Blacktown Cancer and Haematology Centre, Sydney, New South Wales, Australia.
⁷ Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.
⁸ University of Notre Dame, Sydney, New South Wales, Australia.
⁹ Department of Radiation Oncology, Westmead Hospital, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.
¹⁰ Sydney Cellular Therapies Laboratory, Blood and Bone Marrow Transplant Unit, Department of Haematology, Westmead Hospital, Sydney, NSW, Australia.

PMID: 34012652
PMCID: PMC8107615
DOI: 10.21037/jgo-20-300

Outcomes of young patients diagnosed with locally advanced rectal cancer

Rosemary Habib et al. J Gastrointest Oncol. 2021 Apr.

. 2021 Apr;12(2):592-601.

doi: 10.21037/jgo-20-300.

Authors

Affiliations

¹ Westmead Clinical School, The University of Sydney, Sydney, Australia.
² Department of Medical Oncology, Westmead Hospital, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.
³ Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
⁴ The Westmead Institute for Medical Research, Westmead, New South Wales, Australia.
⁵ Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
⁶ Blacktown hospital, Blacktown Cancer and Haematology Centre, Sydney, New South Wales, Australia.
⁷ Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.
⁸ University of Notre Dame, Sydney, New South Wales, Australia.
⁹ Department of Radiation Oncology, Westmead Hospital, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.
¹⁰ Sydney Cellular Therapies Laboratory, Blood and Bone Marrow Transplant Unit, Department of Haematology, Westmead Hospital, Sydney, NSW, Australia.

PMID: 34012652
PMCID: PMC8107615
DOI: 10.21037/jgo-20-300

Abstract

Background: The incidence of rectal cancer is higher in the older population. In developed nations, there has been a rise in incidence in young onset colorectal cancer (CRC). We examined the outcomes of locally advanced rectal cancer (LARC) in younger patients (yRC) compared with older patients, using a retrospective audit.

Methods: All cases of LARC referred to two tertiary referral cancer centres in Western Sydney were examined. Patient demographics, presenting symptoms, treatment, relapse free survival (RFS), overall survival (OS) and progression free survival (PFS) were obtained. Under 50 years old was used as the cut-off age for defining yRC.

Results: All 145 consecutive patients were treated for LARC, including 28 in the yRC and 117 in the older patient group. Median follow-up was 54 months. yRC were more likely to complete neoadjuvant therapy (100% vs. 86%; P=0.032) and to undergo more extensive surgical procedures (24% vs. 2%, P<0.0001). yRC were more likely to have microsatellite high (MSI) tumours (30% vs. 4.7%; P=0.003). yRC demonstrated significantly poorer RFS compared with the standard group (HR 2.79; median RFS 4.67 vs. 16.02 months; P=0.023). In the relapsed setting, yRC had poorer PFS compared with the standard group (median PFS 2.66 vs. 9.70, P=0.006, HR 3.04). A difference in OS was also seen between the two groups, with yRC demonstrating poorer OS (median OS 40.46 vs. 58.26 months, HR 3.48, P=0.036).

Conclusions: Patients under 50 years with LARC are more likely to have MSI tumours with a more aggressive disease course and poorer RFS, PFS and OS. Initiatives to improve early detection of these patients may improve outcomes. Further research is necessary to understand this disease and optimise its treatment.

Keywords: Rectal cancer; cancer; colorectal cancer (CRC); neoadjuvant treatment; rectal bleeding.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jgo-20-300). The authors have no conflicts of interest to declare.

Figures

**Figure 1**
RFS by age. Red: standard group, blue: yRC (P=0.023). RFS, relapse free survival; yRC, younger patients.

**Figure 2**
OS for young onset rectal cancer compared with the standard group (P=0.235). OS, overall survival.

**Figure 3**
OS for relapsed disease for yRC compared with the standard group. Red: standard group, blue: yRC (P=0.036).

See this image and copyright information in PMC

References

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Outcomes of young patients diagnosed with locally advanced rectal cancer

Affiliations

Outcomes of young patients diagnosed with locally advanced rectal cancer

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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