EP160 - Age Does Not Define Outcome: Comparable Oncologic Results in Early- and Late-Onset Locally Advanced Rectal Cancer After Total Neoadjuvant Therapy

ePoster Presenter(s)

• 

  Sowmya Sharma, MD

  Colon and Rectal Surgery Fellow
  Beth Israel Deaconess Medical Center
  Beth Israel Deaconess Medical Center
  Boston, MA, United States

  Disclosure information not submitted.

Author(s)

• SP

  Spyridon Papadimatos, MD

  Postdoctoral Research Fellow
  Beth Israel Deaconess Medical Center, Harvard Medical School
  Boston, Massachusetts, United States

  Disclosure information not submitted.
• 

  Alexander A. Xu, MD, MS (he/him/his)

  Fellow
  Beth Israel Deaconess Medical Center
  Boston, MA, United States

  Disclosure information not submitted.
• DW

  Daniel Wong, MD MHS

  Assistant Professor
  Beth Israel Deaconess Medical Center, Harvard Medical School
  Boston, Massachusetts, United States

  Disclosure information not submitted.
• KC

  Kristen Crowell, MD

  Assistant Professor
  Beth Israel Deaconess Medical Center, Harvard Medical School
  Harvard Medical School
  Boston, MA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• TC

  Thomas E. Cataldo, MD

  Assistant Prof of SUrgery
  Harvard Medical School
  Boston, Massachusetts, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Senior Author(s)

• 

  Evangelos Messaris, MD

  Division Chief
  Beth Israel Deaconess Medical Center - Harvard Medical School
  Boston, Massachusetts, United States

  Disclosure information not submitted.

Purpose/Background: The incidence of early-onset rectal cancer (EORC, < 50 years) continues to rise, yet it remains unclear whether younger age at diagnosis confers a survival advantage in patients with locally advanced disease. This study compares overall survival (OS) and recurrence-free survival (RFS) between patients with early-onset and late-onset locally advanced rectal cancer (LARC) who underwent total neoadjuvant therapy (TNT) with curative intent.

Methods/Interventions: We performed a retrospective review of all the patients with LARC (Stage II and III) who underwent TNT between 2019 and 2024 at our institution. These patients were categorized based on age (≤50 vs >50). Patients with other treatment modalities than TNT were excluded. Demographics, tumor location, response to TNT and subsequent management were reviewed. Recurrence and need for salvage surgery were also recorded. Disease-free survival (DFS) and overall survival (OS) were estimated using Kaplan-Meier methodology with log rank testing.

Results/Outcomes: A total of 103 patients with locally advanced rectal cancer were included, of whom 35 (34%) were age ≤50 and 68 (66%) were age >50 at diagnosis. The mean ages were 43 and 64 years, respectively. Baseline demographic and clinical characteristics, including sex, BMI, and race distribution, were similar between the two groups. The majority of patients in both cohorts presented with stage III disease (94% vs. 87%, p=0.32), and tumor location within the rectum did not differ significantly.

Response to total neoadjuvant therapy (TNT) was comparable between age groups, with similar rates of complete or near-complete response (46% vs. 49%, p=0.34). Watch-and-wait management was employed at similar frequencies (31% vs. 32%, p=1.00), with tumor regrowth observed in 27% of younger and 9% of older patients managed nonoperatively (p=0.33).

After a median follow-up of 37 months, recurrence occurred in 24% of younger and 19% of older patients (p=0.61). The distribution of local versus distant recurrence was not significantly different. No deaths occurred among patients ≤50 years, compared with 9% mortality in those >50 years (p=0.17). Median follow-up duration was similar between groups (37 vs. 36 months, p=0.97).

Conclusion/Discussion: Patients with early-onset (≤50 years) and late-onset locally advanced rectal cancer treated with total neoadjuvant therapy and when needed surgery demonstrated comparable treatment response, recurrence, and survival. Younger age did not confer a survival advantage, suggesting that outcomes in rectal cancer are more closely related to tumor biology and treatment response than to patient age at diagnosis.

Table 1: Characteristics of Patients and Cancers Diagnosed Before and After Age 50