Worse prognosis in young patients with locally advanced rectal cancer following neoadjuvant chemoradiotherapy A comparative study

To determine the efficacy of neoadjuvant chemoradiotherapy (NCRT) between young and old patients with locally advanced rectal cancer (LARC) in terms of tumor response and survival outcome. LARC patients undergoing NCRT and radical surgery from 2011 to 2015 were included and divided into: young (aged <= 50 years) and old group (aged >50 years). Multivariate analyses were performed to identify risk factors for local recurrence. Least absolute shrinkage and selection operator analysis was performed to identify risk factors for overall survival. Predicting nomograms and time-indepent receiver operating characteristic curve analysis were performed to compare the models containing with/withour age groups. A total of 572 LARC patients were analyzed. The young group was associated with higher pathological TNM stage, poorly differentiated tumors, and higher rate of positive distal resection margin (P = .010;P = .019;P = .023 respectively). Young patients were associated with poorer 5-year disease-free survival and local recurrence rates (P = .023,P = .003 respectively). Cox regression analysis demonstrated that age <= 50 years (Hazard ratio = 2.994,P = .038) and higher pathological TNM stage (Hazard ratio = 3.261,P = .005) were significantly associated with increased risk for local recurrence. Least absolute shrinkage and selection operator analysis and the time-indepent receiver operating characteristic curve analysis demonstrated that including the age group were superior than that without age group. Young patients were associated with poorer disease free survival (DFS) and a higher risk for local recurrence in LARC following NCRT. The predicting model basing based on the age group had a better predictive ability. More intense adjuvant treatment could be considered to improve DFS and local control for young patients with LARC following NCRT.