Worse treatment response to neoadjuvant chemoradiotherapy in young patients with locally advanced rectal cancer

Yiyi Zhang,Meifang Xu,Xing Liu,Guoxian Guan,Yong Wu,Liangliang Yan

doi:10.1186/s12885-020-07359-2

Abstract

BackgroundTo evaluate the impact of age on the efficacy of neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced rectal cancer (LARC).MethodLARC patients undergoing NCRT and radical surgery from 2011 to 2018 were divided into young (< 40 years) and old (≥40 years) groups. Multivariate analyses were performed to identify predictive factors for pathological complete response (pCR). Predictive nomograms and decision curve analysis were used to compare the models including/excluding age groups. Immunohistochemical analysis was performed to detect CD133 expression in LARC patients.ResultA total of 901 LARC patients were analyzed. The young group was associated with poorly differentiated tumors, more metastatic lymph nodes, higher perineural invasion, and a lower tumor regression grade (P = 0.008; P < 0.001; P < 0.001; P = 0.003). Logistic regression analysis demonstrated that age < 40 years (HR = 2.190, P = 0.044), tumor size (HR = 0.538, P < 0.001), pre-NCRT cN stage (HR = 0.570, P = 0.036), and post-NCRT CEA level (HR = 0.877, P = 0.001) were significantly associated with pCR. Predictive nomograms and decision curve analysis demonstrated that the predictive ability of models including the age group was superior to that of models excluding the age group. Higher CD133 expression was more common in young LARC patients.ConclusionYoung patients with LARC were associated with lower pCR rates following NCRT. The ability of the predictive model was greater when based on the age group. Young LARC patients were associated with a higher CD133+ tumor stem cell burden, which contributed to the lower pCR rates.

Highlights

To evaluate the impact of age on the efficacy of neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced rectal cancer (LARC)
Our study demonstrated that young patients have a higher proportion of Cancer stem cells (CSCs) (CD133+), which might contribute to the lower pathological complete response (pCR) rates
Young LARC patients often present with aggressive pathological features and advanced stage compared with older patients [4,5,6]

Summary

Introduction

To evaluate the impact of age on the efficacy of neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced rectal cancer (LARC). CRC is generally thought to be a malignancy affecting the elderly patients. Over the last two decades, the incidence of CRC has increased in young individuals, especially those aged under 40. Most studies focus on older CRC patients, especially the elderly (> 70 years) [2, 3]. Few studies have focused on the impact of young age (< 40 years) in CRC patients. In contrast to CRC in the elderly, young patients present at a more advanced tumor stage, with a more aggressive pathological subtype, and poor prognosis [4,5,6]. The increasing prevalence in CRC patients aged < 40 years highlights a genuine need to better understand this disease in such patients

Results

Discussion

Conclusion