Background: Recent population-based studies have highlighted a disproportionate increase in the incidence of rectal cancer among adults younger than aged 50 years. To determine whether different intervention and surveillance strategies might be needed for younger patients, the patterns of care and oncologic outcomes among adults younger than aged 50 years with rectal cancer were investigated. Methods: A cohort of 333 young (<50 years) patients with sporadic rectal cancer was compared to a contemporaneous cohort of 675 older (>65 years) patients for differences in disease pattern, treatments received, and long-term disease-free survival (DFS). Results: Patient and tumor characteristics did not differ between groups except for an increased presence of signet-ring and mucinous histology in young patients. Younger patients presented with more advanced-stage disease (stages III and IV: 59.4% vs. 46.4%; p = 0.016). More young patients received sphincter-preservation procedures (63.4 vs. 55.4%; p = 0.016), radiation (61.6 vs. 42.1%; p < 0.001), and chemotherapy (67.3 vs. 47.6%; p < 0.001). Fewer young patients were free from recurrent disease at the last follow-up (72.1 vs. 82.5%; p < 0.001). The stage-specific 5-year DFS did not differ between the young and older cohorts. Only stage and the need for chemotherapy independently predicted poor DFS. Conclusions: Young patients present at a later stage and a greater proportion develop distant disease recurrence over time. However, their stage-specific oncologic outcomes appear similar to those in older-onset patients. To have the greatest impact on long-term oncologic outcomes in patients with young-onset rectal cancer, future interventions should target strategies to diagnosis rectal cancer earlier, and once diagnosed, closer surveillance for recurrence may be warranted.
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