Worse treatment response to neoadjuvant chemoradiotherapy in young patients with locally advanced rectal cancer
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RESEARCH ARTICLE
Open Access
Worse treatment response to neoadjuvant chemoradiotherapy in young patients with locally advanced rectal cancer Yiyi Zhang1†, Liangliang Yan2†, Yong Wu1†, Meifang Xu3, Xing Liu1* and Guoxian Guan1*
Abstract Background: To evaluate the impact of age on the efficacy of neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced rectal cancer (LARC). Method: LARC 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. Result: A 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. Conclusion: Young 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. Keywords: Age, pCR, Prognosis, LARC, CD133
Background Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related mortality in the USA [1]. 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. * Correspondence: [email protected]; [email protected] † Yiyi Zhang, Liangliang Yan, and Yong Wu contributed equally to this work. 1 Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China Full list of author information is available at the end of the article
However, 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 [4–6]. The increasing prevalence in CRC patients aged < 40 years highlights a genuine need to better understand this disease in such patients. Neoadjuvant chemoradi
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