Introduction: The incidence of rectal cancer in young patients is increasing; recent literature suggests that some clinical characteristics may influence the major rate of recurrence and lesser overall survival in comparison with adult patients. The present study aimed to explore the clinical characteristics of patients with early-onset (<40 years) rectal cancer (Group A) versus rectal carcinomas seen in patients >40 years of age (Group B).
Methods: We performed a retrospective cohort analysis from January 2000 to December 2014. We enrolled patients with LARC who received CRT.
Results: Our study comprised 413 patients, 80 (20%) patients in group A and 333 (805) in group B. The main differences in Group A vs Group B are: 41 patients (51%) are male vs 207 (62%), poor histologic grade in 18 patients (22.5%) in group A vs 39 patients (11.7%), body mass index >30 in 4 patients (5%) in group A vs 52 patients (15.6%), carcinoembrionic antigen (CEA) >10ng/ml in 43 patients (53.8%) vs 104 patients (31.2%) in group B and required colostomy before CRT treatment in 22 patients (27.5%) in group A vs 71 patients (21.32%) in group B. All patients received fluoropyrimidine based chemotherapy concurrent with radiotherapy (45-50.4Gy), after clinical, tomographic, endoscopic and histological evaluation in 10 patients (12.5%) of group A the radical surgery was refused vs 63 patients (19%), 12 patients (15%) in group A had disease progression vs 26 patients (7.8%), irresectability in 9 patients (11.25%) in group A vs 31 patients (9.3%) and radical surgery in 49 patients (61.2%) vs 205 patients (61.6%), of these 4 patients in group A (8%) achieved pathological complete response (pCR) vs 42 patients (20.5%), positive margin in 11 patients in group A (22.4%) vs 21 (10.24%), one or more positive lymph node in 21 patients (42.9%) vs 51 (24.9%) and recurrence in 23 patients (47%) vs 64 (31.2%).
Conclusion: Our study demonstrates that patients <40 years have poor predictive prognosis: CEA elevation, poor histologic grade, achieved lesser pCR, more percentage of positive margin, positive lymph nodes and rates of recurrence.