Rectal cancer patients younger than 50 years lack a survival benefit from NCCN guideline-directed treatment for stage II and III disease.
Rectal cancer patients younger than 50 years lack a survival benefit from NCCN guideline-directed treatment for stage II and III disease.
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50岁以下患者的直肠癌发病率正在增加。为了验证这一假设，即这个年轻队列的生物学可能不同，这项研究比较了生存模式，根据国家综合癌症网络（NCCN）指南驱动的护理和年龄对患者进行分层。在国家癌症数据库中查询了2004年至2014年期间接受根治性经腹切除术治疗的I至III期直肠癌患者，手术切缘阴性。根据NCCN指南驱动的护理，按亚组比较50岁以下患者和50岁或以上患者的结局和总生存期。共分析了43，106例患者。年轻患者更有可能是女性和少数民族，在更高的阶段被诊断出来，并在学术/综合中心接受治疗。短期和长期的结果是显着更好的年龄小于50岁的患者，与年龄特异性生存率计算。年轻患者更有可能接受NCCN I期疾病指南以外的放射治疗。在年轻患者中，II期和III期疾病的新辅助放化疗与总生存率获益无关。直肠癌根治性治疗患者的特定生存期数据不支持NCCN指南驱动的治疗对50岁以下的II期和III期患者的总生存期获益。这些数据表明，早发性疾病可能在生物学上和对多模式治疗的反应上有所不同。
The incidence of rectal cancer in patients younger than 50 years is increasing. To test the hypothesis that the biology in this younger cohort may differ, this study compared survival patterns, stratifying patients according to National Comprehensive Cancer Network (NCCN) guideline–driven care and age. The National Cancer Data Base was queried for patients treated with curative-intent transabdominal resections with negative surgical margins for stage I to III rectal cancer between 2004 and 2014. Outcomes and overall survival for patients younger than 50 years and patients 50 years old or older were compared by subgroups based on NCCN guideline–driven care. A total of 43,106 patients were analyzed. Younger patients were more likely to be female and minorities, to be diagnosed at a higher stage, and to have travelled further to be treated at academic/integrated centers. Short- and long-term outcomes were significantly better for patients younger than 50 years, with age-specific survival rates calculated. Younger patients were more likely to receive radiation treatment outside NCCN guidelines for stage I disease. In younger patients, the administration of neoadjuvant chemoradiation for stage II and III disease was not associated with an overall survival benefit. Age-specific survival data for patients with rectal cancer treated with curative intent do not support an overall survival benefit from NCCN guideline–driven therapy for stage II and III patients younger than 50 years. These data suggest that early-onset disease may differ biologically and in its response to multimodality therapy.
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影响因子：
16.9
作者：
Bailey CE;Hu CY;You YN;Bednarski BK;Rodriguez-Bigas MA;Skibber JM;Cantor SB;Chang GJ
通讯作者：
Chang GJ
影响因子：
45.3
作者：
Gill, S;Loprinzi, CL;Goldberg, RM
通讯作者：
Goldberg, RM
影响因子：
9
作者：
Monson, John R. T.;Probst, Christian P.;Dietz, David W.
通讯作者：
Dietz, David W.
影响因子：
8.9
作者：
Ahnen, Dennis J.;Wade, Sally W.;You, Y. Nancy
通讯作者：
You, Y. Nancy
影响因子：
39.2
作者：
Pignone, M;Rich, M;Lohr, KN
通讯作者：
Lohr, KN