October 28, 2011 (San Francisco, California) — The incidence of rectal adenocarcinoma has more than doubled among persons younger than 40 years of age, and such tumors are 5 times more likely to have a signet cell histology suggestive of an aggressive phenotype, according to a study presented here at the American College of Surgeons (ACS) 97th Clinical Congress.
"Given the worse outcomes associated with signet cell histology, these data highlight the need to identify and address the cause of this emerging problem," said Patrick S. Tawadros, MD, PhD, from the University of Minnesota in Minneapolis.
The increasing incidence of rectal cancer among young adults has been reported in the literature in recent years. Dr. Tawadros said his own interest in this topic stemmed from a 26-year-old patient of his.
"In my first week of fellowship I had a young patient with very advanced rectal cancer anteriorally invading to his right seminal vesicle. He required a multivisceral resection at 26 years old. And I went on to see other patients under the age of 40. Although there is probably a selection bias for patients seen at the University of Minnesota, this made me question what we know about the possible rise in rectal cancer among young adults," he said.
Recent studies have, indeed, suggested that rectal cancer rates are rising among younger adults and their disease tends to be more advanced at presentation, which led Dr. Tawadros and colleagues to question whether signet cell histology might be playing a role, he said.
Signet cell histology is rare, occurring in only about 1% of rectal cancers. It is associated with advanced stage at presentation, young age, and worse prognosis.
"We hypothesized that an increased incidence of rectal cancer in young persons may be associated with an increased signet ring cell phenotype," he said.
He and his colleagues performed a retrospective cohort study of all patients diagnosed with rectal adenocarcinoma from 1980 to 2007 using the Surveillance, Epidemiology, and End Results (SEER) cancer registry (n = 117,813). They found that although the incidence of rectal cancer for all ages remained stable from 1980 to 2007, there was essentially a doubling since the year 2000 in malignancies in persons younger than 40 years of age.
Among this younger age group, the incidence has increased linearly from 0.4 to 1.2 per 100,000 population, he said.
Importantly, and as they hypothesized, they found a significantly higher prevalence of signet cell histology in young adults than in patients older than age 40 (4.63% vs 0.78%; P = .001).
"Signet cell histology comprised about 5% of rectal adenocarcinomas in patients under the age of 40, compared with 1% in patients over 40," he reported.
Multivariate regression analysis revealed an adjusted odds ratio of 5.12 (95% confidence interval, 4.22 - 6.20) for signet cell histology in rectal adenocarcinoma in persons younger than age 40 years.
Signet cell histology was also significantly associated with more advanced stage at presentation, poorly differentiated tumor grade, and worse prognosis compared with mucinous and nonmucinous rectal adenocarcinoma.
"Given the worse outcomes associated with signet cell histology, these data highlight the need to identify and address the cause of this emerging problem. Young adults with lower gastrointestinal symptoms should undergo prompt evaluation and not just assumed to have bleeding hemorrhoids," he said.
Martin R. Weiser, MD, from Memorial Sloan-Kettering Cancer Center in New York, New York, said the findings should bring much-needed awareness to clinicians. "Anecdotally, we have often seen young patients present with signet histology, and these are the patients that often do quite poorly with chemoradiation and surgery. They have very aggressive tumors. We should be aware of this when we see young patients with this histology."
Dr. Tawadros and Dr. Weiser have disclosed no relevant financial relationships.
American College of Surgeons 97th Annual Clinical Congress. Presented October 26, 2011.
"Given the worse outcomes associated with signet cell histology, these data highlight the need to identify and address the cause of this emerging problem," said Patrick S. Tawadros, MD, PhD, from the University of Minnesota in Minneapolis.
The increasing incidence of rectal cancer among young adults has been reported in the literature in recent years. Dr. Tawadros said his own interest in this topic stemmed from a 26-year-old patient of his.
"In my first week of fellowship I had a young patient with very advanced rectal cancer anteriorally invading to his right seminal vesicle. He required a multivisceral resection at 26 years old. And I went on to see other patients under the age of 40. Although there is probably a selection bias for patients seen at the University of Minnesota, this made me question what we know about the possible rise in rectal cancer among young adults," he said.
Recent studies have, indeed, suggested that rectal cancer rates are rising among younger adults and their disease tends to be more advanced at presentation, which led Dr. Tawadros and colleagues to question whether signet cell histology might be playing a role, he said.
Signet cell histology is rare, occurring in only about 1% of rectal cancers. It is associated with advanced stage at presentation, young age, and worse prognosis.
"We hypothesized that an increased incidence of rectal cancer in young persons may be associated with an increased signet ring cell phenotype," he said.
He and his colleagues performed a retrospective cohort study of all patients diagnosed with rectal adenocarcinoma from 1980 to 2007 using the Surveillance, Epidemiology, and End Results (SEER) cancer registry (n = 117,813). They found that although the incidence of rectal cancer for all ages remained stable from 1980 to 2007, there was essentially a doubling since the year 2000 in malignancies in persons younger than 40 years of age.
Among this younger age group, the incidence has increased linearly from 0.4 to 1.2 per 100,000 population, he said.
Importantly, and as they hypothesized, they found a significantly higher prevalence of signet cell histology in young adults than in patients older than age 40 (4.63% vs 0.78%; P = .001).
"Signet cell histology comprised about 5% of rectal adenocarcinomas in patients under the age of 40, compared with 1% in patients over 40," he reported.
Multivariate regression analysis revealed an adjusted odds ratio of 5.12 (95% confidence interval, 4.22 - 6.20) for signet cell histology in rectal adenocarcinoma in persons younger than age 40 years.
Signet cell histology was also significantly associated with more advanced stage at presentation, poorly differentiated tumor grade, and worse prognosis compared with mucinous and nonmucinous rectal adenocarcinoma.
"Given the worse outcomes associated with signet cell histology, these data highlight the need to identify and address the cause of this emerging problem. Young adults with lower gastrointestinal symptoms should undergo prompt evaluation and not just assumed to have bleeding hemorrhoids," he said.
Martin R. Weiser, MD, from Memorial Sloan-Kettering Cancer Center in New York, New York, said the findings should bring much-needed awareness to clinicians. "Anecdotally, we have often seen young patients present with signet histology, and these are the patients that often do quite poorly with chemoradiation and surgery. They have very aggressive tumors. We should be aware of this when we see young patients with this histology."
Dr. Tawadros and Dr. Weiser have disclosed no relevant financial relationships.
American College of Surgeons 97th Annual Clinical Congress. Presented October 26, 2011.
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