Rectal cancer in young Indians--are these cancers different compared to their older counterparts?
BACKGROUND
The incidence of rectal cancer in young Indians is increasing. Recent evidence suggests a probable existence of noncanonical tumorigenesis pathways in early-onset colorectal cancer patients in India. The aim of the study was to evaluate rectal cancer outcomes in patients ≤40 years with those >40 years.


METHODS
An analysis of a prospective database of surgically treated rectal cancer patients ≤40 years (group 1) and those >40 years (group 2) over 2 years was performed. Clinicopathological features, perioperative outcomes, and disease-free survival (DFS) were analyzed.


RESULTS
Of the 512 patients with colorectal cancer treated surgically, 237 patients (group 1-57 patients; group 2-180 patients) were diagnosed with nonmetastatic rectal adenocarcinoma. Patients in group 1 were more likely to present with locally advanced (stage III) disease (p < 0.005) resulting in a higher proportion of them receiving neoadjuvant chemoradiotherapy (NACT-RT). There was no difference in morbidity and mortality between the two groups. Younger patients had a significantly higher median total and positive lymph node yield (p < 0.003). Patients in group 1 had a significantly lower overall DFS (p < 0.005). Stage-specific DFS also demonstrated a significantly lower trend in stage III patients in group 1.


CONCLUSIONS
Young rectal cancer patients in India tended to present more frequently with locally advanced tumors resulting in a higher proportion being treated with NACT-RT. Stapled rectal anastomoses could be performed safely in young patients even after NACT-RT. The significantly poorer DFS in young Indian patients with stage III disease was a novel finding and merits further investigation into tumor biology.
Department of Gastrointestinal and Hepatopancreatobiliary Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai, 400 012, India.
Savio George
SG
Barreto
Gaurav N
GN
Chaubal
Sanjay
S
Talole
Ashwin
A
DeSouza
Kunal
K
Suradkar
Vinay
V
Gaikwad
Mahesh
M
Goel
Shailesh V
SV
Shrikhande
D000230:Adenocarcinoma / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult