Are survival rates different for young and old patients with rectal cancer?

Abstract

Introduction: While it is generally believed that young patients with rectal cancer may have worse overall and stage-specific survival, no comprehensive analysis has been reported. Nearly all studies to date have reported the experiences of single institutions and may not be representative of the population. This study uses a national level population-based cancer registry to compare rectal cancer outcomes between the young versus older population. Methods: All patients with rectal carcinoma in the SEER cancer database from 1991–1999 were evaluated. A young group (20–40 y/o, n = 466) and an older group (60–80 y/o, n = 11,312) were compared for patient and tumor characteristics, patterns of treatment, and 5-year overall and stage-specific survival. Multivariate Cox regression analysis was performed to predict hazard ratios for death. Results: Mean ages for the groups were 34.1 and 70.0 years; 60% were male (in both groups). The young group was comprised of fewer white, more black, and more Hispanic patients as compared to the older group (p < 0.001). Young patients presented with less stage I disease (17% vs. 23.7%, p < 0.001), and more stage III (27% vs. 20%, p < 0.001) and stage IV disease (17% vs. 13%, p < 0.02). The younger group also had worse grade tumors (poorly differentiated, 31% vs. 17%, p < 0.001). While 85% of both groups received surgical treatment, a significantly higher proportion of younger patients received appropriate stage-related radiation treatment (p < 0.001). Importantly, while the overall 5-year survival was significantly worse for the young group, no differences in stage-specific 5-year survival rates were identified between the young as compare to the older group (Table 1). Conclusions: This study demonstrates that young rectal cancer patients have poorer overall survival, but equivalent stage-for-stage survival. The observed difference in overall survival is likely due to the finding that younger patients present with more advanced stage disease. Future studies should continue to use data that is representative of the population when performing these types of epidemiologic and outcomes-related analyses.