Benchmarking Outcomes for Definitive Treatment of Young-Onset, Locally Advanced Rectal Cancer

Nicolette Taku; Y. Nancy Yi-Qian; George J. Chang; Ethan B. Ludmir; Kanwal Pratap Singh Raghav; Miguel A. Rodriguez-Bigas; Emma Brey Holliday; Grace L. Smith; Bruce D. Minsky; Michael J. Overman; Craig Messick; David Boyce-Fappiano; Albert C. Koong; John Michael Skibber; Eugene Jon Koay; Arvind Dasari; Cullen M. Taniguchi; Brian K. Bednarski; Van K. Morris; Scott Kopetz; Prajnan Das

doi:10.1016/j.clcc.2021.09.012

Benchmarking Outcomes for Definitive Treatment of Young-Onset, Locally Advanced Rectal Cancer

Nicolette Taku, Y. Nancy Yi-Qian, George J. Chang, Ethan B. Ludmir, Kanwal Pratap Singh Raghav, Miguel A. Rodriguez-Bigas, Emma Brey Holliday, Grace L. Smith, Bruce D. Minsky, Michael J. Overman, Craig Messick, David Boyce-Fappiano, Albert C. Koong, John Michael Skibber, Eugene Jon Koay, Arvind Dasari, Cullen M. Taniguchi, Brian K. Bednarski, Van K. Morris, Scott KopetzPrajnan Das

Research output: Contribution to journal › Article › peer-review

Abstract

PURPOSE: There has been an increase in the incidence of rectal cancer diagnosed in young adults (age < 50 years). We evaluated outcomes among young adults treated with pre-operative long course chemoradiation (CRT) and total mesorectal excision (TME).

METHODS: The medical records of 219 patients, age 18-49, with non-metastatic, cT3-4, or cN1-2 rectal adenocarcinoma treated from 2000 to 2017 were reviewed for demographic and treatment characteristics, as well as pathologic and oncologic outcomes. The Kaplan-Meier test, log-rank test, and Cox regression analysis were used to evaluate survival outcomes.

RESULTS: The median age at diagnosis was 44 years. CRT followed by TME and post-operative chemotherapy was the most frequent treatment sequence (n = 196), with FOLFOX (n = 115) as the predominant adjuvant chemotherapy. There was no difference in sex, stage, MSS/pMMR, or pCR by age (< 45 years [n = 111] vs. ≥ 45 years [n = 108]). The 5-year rates of DFS were 77.2% for all patients, 69.8% for age < 45 years and 84.7% for age ≥ 45 years (P = .01). The 5-year rates of OS were 89.6% for all patients, 85.1% for patients with age < 45 years and 94.3% for patients with age ≥ 45 years (P = .03). Age ≥ 45 years was associated with a lower risk of disease recurrence or death on multivariable Cox regression analysis (HR = 0.55, 95% CI 0.31-0.97, P = .04).

CONCLUSION: Among young adults, patients with age < 45 years had lower rates of DFS and OS, compared to those with age ≥ 45 years. These outcomes could serve as a benchmark by which to evaluate newer treatment approaches.

Original language	English (US)
Pages (from-to)	e28-e37
Journal	Clinical colorectal cancer
Volume	21
Issue number	1
DOIs	https://doi.org/10.1016/j.clcc.2021.09.012
State	Published - Mar 2022

Keywords

Colorectal cancer
Gastrointestinal cancer
Radiation oncology
Surgical oncology
Young adults
Rectal Neoplasms/epidemiology
Humans
Middle Aged
Benchmarking
Treatment Outcome
Chemoradiotherapy
Antineoplastic Combined Chemotherapy Protocols/therapeutic use
Young Adult
Disease-Free Survival
Adolescent
Adult
Neoadjuvant Therapy
Retrospective Studies
Neoplasm Staging

ASJC Scopus subject areas

Gastroenterology
Oncology

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10.1016/j.clcc.2021.09.012

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Taku, N., Yi-Qian, Y. N., Chang, G. J., Ludmir, E. B., Raghav, K. P. S., Rodriguez-Bigas, M. A., Holliday, E. B., Smith, G. L., Minsky, B. D., Overman, M. J., Messick, C., Boyce-Fappiano, D., Koong, A. C., Skibber, J. M., Koay, E. J., Dasari, A., Taniguchi, C. M., Bednarski, B. K., Morris, V. K., ... Das, P. (2022). Benchmarking Outcomes for Definitive Treatment of Young-Onset, Locally Advanced Rectal Cancer. Clinical colorectal cancer, 21(1), e28-e37. https://doi.org/10.1016/j.clcc.2021.09.012

Taku, N, Yi-Qian, YN, Chang, GJ, Ludmir, EB, Raghav, KPS, Rodriguez-Bigas, MA, Holliday, EB, Smith, GL, Minsky, BD, Overman, MJ, Messick, C, Boyce-Fappiano, D, Koong, AC, Skibber, JM, Koay, EJ, Dasari, A, Taniguchi, CM, Bednarski, BK, Morris, VK, Kopetz, S & Das, P 2022, 'Benchmarking Outcomes for Definitive Treatment of Young-Onset, Locally Advanced Rectal Cancer', Clinical colorectal cancer, vol. 21, no. 1, pp. e28-e37. https://doi.org/10.1016/j.clcc.2021.09.012

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title = "Benchmarking Outcomes for Definitive Treatment of Young-Onset, Locally Advanced Rectal Cancer",

abstract = "PURPOSE: There has been an increase in the incidence of rectal cancer diagnosed in young adults (age < 50 years). We evaluated outcomes among young adults treated with pre-operative long course chemoradiation (CRT) and total mesorectal excision (TME).METHODS: The medical records of 219 patients, age 18-49, with non-metastatic, cT3-4, or cN1-2 rectal adenocarcinoma treated from 2000 to 2017 were reviewed for demographic and treatment characteristics, as well as pathologic and oncologic outcomes. The Kaplan-Meier test, log-rank test, and Cox regression analysis were used to evaluate survival outcomes.RESULTS: The median age at diagnosis was 44 years. CRT followed by TME and post-operative chemotherapy was the most frequent treatment sequence (n = 196), with FOLFOX (n = 115) as the predominant adjuvant chemotherapy. There was no difference in sex, stage, MSS/pMMR, or pCR by age (< 45 years [n = 111] vs. ≥ 45 years [n = 108]). The 5-year rates of DFS were 77.2% for all patients, 69.8% for age < 45 years and 84.7% for age ≥ 45 years (P = .01). The 5-year rates of OS were 89.6% for all patients, 85.1% for patients with age < 45 years and 94.3% for patients with age ≥ 45 years (P = .03). Age ≥ 45 years was associated with a lower risk of disease recurrence or death on multivariable Cox regression analysis (HR = 0.55, 95% CI 0.31-0.97, P = .04).CONCLUSION: Among young adults, patients with age < 45 years had lower rates of DFS and OS, compared to those with age ≥ 45 years. These outcomes could serve as a benchmark by which to evaluate newer treatment approaches.",

keywords = "Colorectal cancer, Gastrointestinal cancer, Radiation oncology, Surgical oncology, Young adults, Rectal Neoplasms/epidemiology, Humans, Middle Aged, Benchmarking, Treatment Outcome, Chemoradiotherapy, Antineoplastic Combined Chemotherapy Protocols/therapeutic use, Young Adult, Disease-Free Survival, Adolescent, Adult, Neoadjuvant Therapy, Retrospective Studies, Neoplasm Staging",

author = "Nicolette Taku and Yi-Qian, {Y. Nancy} and Chang, {George J.} and Ludmir, {Ethan B.} and Raghav, {Kanwal Pratap Singh} and Rodriguez-Bigas, {Miguel A.} and Holliday, {Emma Brey} and Smith, {Grace L.} and Minsky, {Bruce D.} and Overman, {Michael J.} and Craig Messick and David Boyce-Fappiano and Koong, {Albert C.} and Skibber, {John Michael} and Koay, {Eugene Jon} and Arvind Dasari and Taniguchi, {Cullen M.} and Bednarski, {Brian K.} and Morris, {Van K.} and Scott Kopetz and Prajnan Das",

note = "Publisher Copyright: {\textcopyright} 2021",

year = "2022",

month = mar,

doi = "10.1016/j.clcc.2021.09.012",

language = "English (US)",

volume = "21",

pages = "e28--e37",

journal = "Clinical colorectal cancer",

issn = "1533-0028",

publisher = "Elsevier",

number = "1",

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TY - JOUR

T1 - Benchmarking Outcomes for Definitive Treatment of Young-Onset, Locally Advanced Rectal Cancer

AU - Taku, Nicolette

AU - Yi-Qian, Y. Nancy

AU - Chang, George J.

AU - Ludmir, Ethan B.

AU - Raghav, Kanwal Pratap Singh

AU - Rodriguez-Bigas, Miguel A.

AU - Holliday, Emma Brey

AU - Smith, Grace L.

AU - Minsky, Bruce D.

AU - Overman, Michael J.

AU - Messick, Craig

AU - Boyce-Fappiano, David

AU - Koong, Albert C.

AU - Skibber, John Michael

AU - Koay, Eugene Jon

AU - Dasari, Arvind

AU - Taniguchi, Cullen M.

AU - Bednarski, Brian K.

AU - Morris, Van K.

AU - Kopetz, Scott

AU - Das, Prajnan

PY - 2022/3

Y1 - 2022/3

N2 - PURPOSE: There has been an increase in the incidence of rectal cancer diagnosed in young adults (age < 50 years). We evaluated outcomes among young adults treated with pre-operative long course chemoradiation (CRT) and total mesorectal excision (TME).METHODS: The medical records of 219 patients, age 18-49, with non-metastatic, cT3-4, or cN1-2 rectal adenocarcinoma treated from 2000 to 2017 were reviewed for demographic and treatment characteristics, as well as pathologic and oncologic outcomes. The Kaplan-Meier test, log-rank test, and Cox regression analysis were used to evaluate survival outcomes.RESULTS: The median age at diagnosis was 44 years. CRT followed by TME and post-operative chemotherapy was the most frequent treatment sequence (n = 196), with FOLFOX (n = 115) as the predominant adjuvant chemotherapy. There was no difference in sex, stage, MSS/pMMR, or pCR by age (< 45 years [n = 111] vs. ≥ 45 years [n = 108]). The 5-year rates of DFS were 77.2% for all patients, 69.8% for age < 45 years and 84.7% for age ≥ 45 years (P = .01). The 5-year rates of OS were 89.6% for all patients, 85.1% for patients with age < 45 years and 94.3% for patients with age ≥ 45 years (P = .03). Age ≥ 45 years was associated with a lower risk of disease recurrence or death on multivariable Cox regression analysis (HR = 0.55, 95% CI 0.31-0.97, P = .04).CONCLUSION: Among young adults, patients with age < 45 years had lower rates of DFS and OS, compared to those with age ≥ 45 years. These outcomes could serve as a benchmark by which to evaluate newer treatment approaches.

AB - PURPOSE: There has been an increase in the incidence of rectal cancer diagnosed in young adults (age < 50 years). We evaluated outcomes among young adults treated with pre-operative long course chemoradiation (CRT) and total mesorectal excision (TME).METHODS: The medical records of 219 patients, age 18-49, with non-metastatic, cT3-4, or cN1-2 rectal adenocarcinoma treated from 2000 to 2017 were reviewed for demographic and treatment characteristics, as well as pathologic and oncologic outcomes. The Kaplan-Meier test, log-rank test, and Cox regression analysis were used to evaluate survival outcomes.RESULTS: The median age at diagnosis was 44 years. CRT followed by TME and post-operative chemotherapy was the most frequent treatment sequence (n = 196), with FOLFOX (n = 115) as the predominant adjuvant chemotherapy. There was no difference in sex, stage, MSS/pMMR, or pCR by age (< 45 years [n = 111] vs. ≥ 45 years [n = 108]). The 5-year rates of DFS were 77.2% for all patients, 69.8% for age < 45 years and 84.7% for age ≥ 45 years (P = .01). The 5-year rates of OS were 89.6% for all patients, 85.1% for patients with age < 45 years and 94.3% for patients with age ≥ 45 years (P = .03). Age ≥ 45 years was associated with a lower risk of disease recurrence or death on multivariable Cox regression analysis (HR = 0.55, 95% CI 0.31-0.97, P = .04).CONCLUSION: Among young adults, patients with age < 45 years had lower rates of DFS and OS, compared to those with age ≥ 45 years. These outcomes could serve as a benchmark by which to evaluate newer treatment approaches.

KW - Colorectal cancer

KW - Gastrointestinal cancer

KW - Radiation oncology

KW - Surgical oncology

KW - Young adults

KW - Rectal Neoplasms/epidemiology

KW - Humans

KW - Middle Aged

KW - Benchmarking

KW - Treatment Outcome

KW - Chemoradiotherapy

KW - Antineoplastic Combined Chemotherapy Protocols/therapeutic use

KW - Young Adult

KW - Disease-Free Survival

KW - Adolescent

KW - Adult

KW - Neoadjuvant Therapy

KW - Retrospective Studies

KW - Neoplasm Staging

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UR - http://www.scopus.com/inward/citedby.url?scp=85119297805&partnerID=8YFLogxK

U2 - 10.1016/j.clcc.2021.09.012

DO - 10.1016/j.clcc.2021.09.012

M3 - Article

C2 - 34794903

AN - SCOPUS:85119297805

SN - 1533-0028

VL - 21

SP - e28-e37

JO - Clinical colorectal cancer

JF - Clinical colorectal cancer

IS - 1

ER -

Benchmarking Outcomes for Definitive Treatment of Young-Onset, Locally Advanced Rectal Cancer

Abstract

Keywords

ASJC Scopus subject areas

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