Rectal Cancer in Patients Younger than 40: Tumor Characteristics and Comparative Survival Based on a Single Institution

Aim: The aim of this study was to determine tumor characteristics and outcomes of patients with rectal cancer <40 years old compared to those above that age at a single institution in Lebanon. Background: The incidence of colorectal cancer is increasing in younger adults as observed from limited available data from the Middle East. Objective: Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan- Meier. Methods: We conducted a retrospective study of patients who were diagnosed with rectal cancer over 15 years. Data were collected regarding demographics, stage, pathology, treatment, and outcomes. Patients were stratified by age, with 40 years as cut-off. Descriptive statistics were conducted. Results: Data for 105 cases were reviewed, 18 patients were aged under 40 years old and 87 patients were above 40 years old. Younger patients had more poorly differentiated tumors than older patients and were more likely to have tumors with signet-ring features. 5-year DFS was 35% and 51.5% for patients below and above 40 years old, respectively (P=0.04). OS was similar in the two age groups, with a median follow-up of 36 months. Conclusion: Further prospective studies with larger sample size and molecular markers are needed to better understand the characteristics of rectal cancer in the young age group. With worse DFS in our study and emerging evidence of a correlation between younger age at diagnosis and poor outcomes, consideration should be given to more personalized upfront intensification of treatment in the young.