Comparable survival for young rectal cancer patients, despite unfavourable morphology and more advanced-stage disease

RG Orsini, RHA Verhoeven, Valery Lemmens, LN van Steenbergen, IHJT de Hingh, GAP Nieuwenhuijzen, HJT Rutten

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29 Citations (Scopus)


Background: Young patients with rectal cancer tend to present with more advanced-stage disease and unfavourable tumour morphology. The effects of these tumour characteristics on survival in this particular patient group are unclear. Methods: Population-based data from the Netherlands Cancer Registry (NCR) were used. Data from patients diagnosed with rectal cancer between 1989 and 2010 were selected. Younger patients (<= 640 years) were compared with middle-aged patients (41-70 years) with respect to disease stage, tumour characteristics, treatment and outcomes. Patients aged older than 70 years were excluded. Relative excess risk (RER) models were used to perform uni- and multivariate survival analyses. Findings: A total of 37.056 patients were included (640 years n = 1.102). Compared with middle-aged patients, young patients were more likely to have stage III (33.8% versus 27.8%) and stage IV (24.3% versus 19.6%) disease (p < 0.001). Young patients also presented more frequently with mucinous tumours (10.8% versus 9.0%), signet cell carcinomas (2.6% versus 0.6%) and poorly differentiated tumours (16.6% versus 12.3%) (p = 0.001). The treatment of stage I-III patients did not differ between the two groups, except regarding adjuvant chemotherapy, which was more often given to young patients (24.3% versus 14.4%, p < 0.001). Young age was a prognostic factor for better survival in stage I-III patients (RER 0.82 CI 0.71-0.94). Adjuvant chemotherapy was associated with improved survival in stage I-III patients (RER 0.76, 95% CI 0.70-0.83). In an exploratory analysis, adjuvant chemotherapy in young stage III and pN1 patients was associated with improved survival. Concluding statement: Young patients present with more advanced disease and have more unfavourable tumour characteristics compared with middle-aged patients. Despite these characteristics, survival rates are equal, and young age is a prognostic factor for better survival. Although the use of adjuvant chemotherapy is controversial, a positive correlation with survival was found in this study. (C) 2015 Elsevier Ltd. All rights reserved.
Original languageUndefined/Unknown
Pages (from-to)1675-1682
Number of pages8
JournalEuropean Journal of Cancer
Issue number13
Publication statusPublished - 2015

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  • EMC NIHES-02-65-02

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