A comparison of organ preservation in older adults with stage I rectal cancer

TL;DR

Older adults with early-stage rectal cancer are more likely to undergo organ preservation than younger patients, despite guidelines favoring major surgery.

Contribution

This study identifies age and other sociodemographic factors as significant predictors of organ preservation in rectal cancer treatment.

Findings

Older adults (≥70 years) had higher organ preservation rates (45.6%) compared to younger patients (30.6%).

Factors like comorbidity, race, and treatment facility type also influenced organ preservation likelihood.

Adjusted analysis confirmed that age remained a strong predictor of organ preservation.

Abstract

Total mesorectal excision (TME) remains the primary recommended treatment for high-risk T1 and T2 rectal cancer. However, growing evidence suggests preoperative therapy may lead to eligibility for organ preservation (OP), avoiding the morbidity of major resection, which may be beneficial in older adults. The primary aim of the study was to compare rates of OP in adults 70 years of age and older to those less than 70 with T1 lesions rectal cancers with high-risk features and T2 rectal cancers.

A retrospective, cohort study of patients with high-risk stage 1 rectal cancer was identified within the National Cancer Database (NCDB). Primary outcome was the association of age with receipt of organ preservation. Multivariate analysis was conducted to examine the effect of covariates on the outcome.

Out of 38,714 patients, 34.4% were ≥ 70 years, 42.3% were female, and 75.6% had a Charlson Deyo comorbidity score of 0. Older adults were more likely to received OP compared to younger patients (45.6% vs 30.6%, p < 0.001). This persisted on adjusted analysis (OR 1.9, p < 0.001). Other factors predictive of receiving OP include non-Hispanic Black race/ethnicity (OR 1.5, p < 0.001), lack of insurance (OR 1.5, p < 0.001), increased comorbidity score (OR 1.7 for CDCC of 3, p < 0.001), treatment at a community facility compared to academic facility (OR 1.4, p < 0.001), and female sex (OR 1.2, p < 0.001).

Although current guideline recommendations for high-risk T1 and T2 rectal cancer is TME, a significantly higher proportion of older adult patients undergo organ preservation. This is more pronounced in comorbid and disadvantaged patients.