title: Young-onset rectal cancer: presentation, pattern of care and long-term oncologic outcomes compared to a matched older-onset cohort.
abstract: 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.
authors: Division of Colorectal Surgery, Mayo Clinic, Rochester, MN, USA. ynyou@mdanderson.org
authors: Y Nancy
authors: YN
authors: You
authors: Eric J
authors: EJ
authors: Dozois
authors: Lisa A
authors: LA
authors: Boardman
authors: Jeremiah
authors: J
authors: Aakre
authors: Marianne
authors: M
authors: Huebner
authors: David W
authors: DW
authors: Larson
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D002288:Adenocarcinoma, Mucinous / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D018279:Carcinoma, Signet Ring Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult