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

Abstract

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.

Clinicopathological features and oncological outcomes of patients with young-onset rectal cancer

“…Although several large series have demonstrated superior oncological outcomes with neoadjuvant chemoradiotherapy compared with surgery alone in locally advanced disease, patients younger than 50 years accounted for only a small percentage of the overall study population in these series. Recent data acquired from a national registry in the USA suggest that multimodal therapy for stage II and III disease may not be associated with an overall survival benefit in patients younger than 50 years, despite greater adherence to National Comprehensive Cancer Network treatment guidelines.…”

Early‐onset colorectal cancer in young individuals

“…In particular, an adjuvant, more intensive schedule of chemotherapy or targeted agents failed to confer a survival benefit and, overall, a more aggressive surgical and adjuvant approach in young CRC patients should not be recommended, since it may lead to overtreatment (Alberts et al ., ; Allegra et al ., ; De Gramont et al ., ; Kneuertz et al ., ; Taieb et al ., ). Combining neo‐adjuvant chemo‐radiotherapy with surgery failed to confer a survival advantage in rectal patients younger than 50 years of age when compared with surgery alone (Kolarich et al ., ). Conversely, oxaliplatin added to standard chemoradiotherapy in patients affected by locally advanced rectal cancer seems to improve disease‐free survival and OS in those < 60 years of age (Hofheinz et al ., ).…”

“…We systematically retrieved 37 articles describing the prognosis of EO‐CRC compared with older patients (Abdelsattar et al ., ; Blanke et al ., ; Boyce et al ., ; Chandrasinghe et al ., ; Chou et al ., , ; Damodaran and Seshadri, ; Fu et al ., ; Fu et al ., ; Haleshappa et al ., ; Hawk et al ., ; Hubbard et al ., ; Josifovski et al ., ; Khan et al ., ; Kim et al ., ; Kneuertz et al ., ; Kolarich et al ., ; Li et al ., ; Lieu et al ., ; Manjelievskaia et al ., ; McMillan and McArdle, ; Murata et al ., ; O'Connell et al ., ; Orsini et al ., ; Pokharkar et al ., ; Quah et al ., ; Rho et al ., ; Rodriguez et al ., ; Shen et al ., ; Shida et al ., ; Sultan et al ., ; Vatandoust et al ., ; Wang et al ., ,; Yang et al ., ; You et al ., ; Zhao et al ., ). EO‐CRC survival data are conflicting.…”

“…In particular, it was reported that the younger the patient, the worse the prognosis (Lieu et al ., ). By contrast, publications comparing patients younger than 50 years of age with those > 50 years showed a better prognosis among the younger patients (Kneuertz et al ., ; Kolarich et al ., ; Vatandoust et al ., ; Wang et al ., ). This suggests that in patients with very early‐onset CRC (< 35 years old) a different biological background likely underlies an earlier and faster CRC progression (Ferrari et al ., ; Indini et al ., ; Khan et al ., ; Zhao et al ., ).…”

“…EO‐CRC survival data are conflicting. Some studies indicate a poorer prognosis (Bleyer et al ., ; Khan et al ., ; Lieu et al ., ; McMillan and McArdle, ; O'Connell et al ., ; Shida et al ., ; Sultan et al ., ), whereas others support a comparable or even better prognosis in comparison with older patients (Blanke et al ., ; Hubbard et al ., ; Kneuertz et al ., ; Kolarich et al ., ; McMillan and McArdle, ; O'Connell et al ., ; Quah et al ., ; Rodriguez et al ., ; Vatandoust et al ., ; Wang et al ., ; You et al ., ; Table ). From 1973 to 2005, adult CRC survival outcome improved, whereas child and adolescent CRC survival have not (Sultan et al ., ).…”