Guideline-Directed Treatment Fails to Extend SG in Younger Patients With Rectal Cancer

According to a retrospective review of the National Cancer Database published in Cancer, the National Comprehensive Cancer Network's recommendations on rectal cancer did not prolong the SG at patients under 50 years old.

"Our results support the notion that rectal cancer in young patients may be biologically different from older patients, with a different response to treatment, as has been previously demonstrated in colon cancer" Atif Iqbal , MD, professor of medicine at the University of Florida College of Medicine said in a press release. Iqbal and colleagues compared survival profiles in different age groups of 43,106 patients with stage I-III rectal cancer using data from 2004 to 2014 from the National. Cancer database The researchers compared the differences between patients under 50 (n = 9,126 men, 58.5%, white, 85.5%) and those over age 50 (n = 33,980 men, 63.9%, white, 87.9%) by subgroups

Younger patients were more likely to be women (41.5% vs. 36.1% ) and belong to an ethnic or racial minority (14.5% vs. 12.1%) than older patients.

A greater proportion of patients under the age of 50 earned $ 63,000 per year or more (35.4% versus 30.6%). In addition, more patients in this age group were more likely to live in a metropolitan area (83.6% vs. 79.8%) and to be treated in an integrated or university center (52%). 6% vs. 46.9%).

Younger patients appeared more likely to be diagnosed at a later stage (stage III, 40% vs 31%; P <.001), and to have lesions ring cells (1.2% vs. 0.5%), as well as poorly differentiated lesions (13% vs. 11.3%).

Younger patients appeared to be more likely to receive radiotherapy than older patients for all stages of the disease, including stage 1 radiotherapy (41.9% vs. 31.7%;] P ] <0.001) and chemoradiation for stage II and III disease (93.6% vs 88.1%; P <0.001).

"Thus, fewer patients in the younger cohort received NCCN-directed treatment for stage I disease, but a larger percentage received for stage II and III disease", writes the researchers. the 30-day mortality rate (2% vs. 0.2%, P <0.001) and the 90-day mortality rate (3.7% vs. 0.5%; P <0.001). This difference became more pronounced at 3, 5 and 10 years.

The researchers then badessed survival by age and reception of care guided by the NCCN guidelines.

Survival improved in older adults with stage II and stage III disease and who received guideline-guided care, as evidenced by a survival benefit of 11% in 10 years.

However, NCCN guideline-guided care resulted in a "significant reduction in survival" in patients younger than 45 years of age with stage II stage III disease P <0.03). Plus, guideline-guided care does not offer any survival benefit until age 50 or older. This benefit only became statistically significant when patients were over 54 years old.

"This article should open the eyes of physicians treating rectal cancer and those who formulate recommendations and screening policies" Matthew F. Kalady, MD, Vice President in the Department of Colorectal surgery at the Cleveland Clinic, wrote in an accompanying editorial. "The alarming trend of increased colorectal cancer in the young population should make us stand up and take note.We need to evaluate why this is happening and explore the unique characteristics that define this population and the potential differences from bad cancers." older rectum. " – by Andy Polhamus

Disclosures: Iqbal does not provide any relevant financial information. One author reports on consulting roles with Bayer and Merck, as well as support from his institution at Astra Zeneca / Med-Immune, Bayer, Bristol-Myers Squibb, Incyte, NewLink and from Tesaro. Kalady does not provide any relevant financial information.