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 journalArticlepeer-review


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 languageEnglish (US)
Pages (from-to)e28-e37
JournalClinical colorectal cancer
Issue number1
StatePublished - Mar 2022


  • 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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