NCCN Guideline Concordance Improves Survival in Pediatric and Young Adult Rectal Cancer

Colleen P Nofi; Sara Siskind; Gary B Deutsch; John P Ricci; Aaron M Lipskar

doi:10.1016/j.jpedsurg.2023.09.042

NCCN Guideline Concordance Improves Survival in Pediatric and Young Adult Rectal Cancer

J Pediatr Surg. 2024 Mar;59(3):464-472. doi: 10.1016/j.jpedsurg.2023.09.042. Epub 2023 Oct 7.

Authors

Colleen P Nofi¹, Sara Siskind², Gary B Deutsch³, John P Ricci³, Aaron M Lipskar⁴

Affiliations

¹ Cohen Children's Medical Center, Division of Pediatric General, Thoracic, and Endoscopic Surgery, 269-01 76th Avenue, Queens NY 11040, USA; Northwell North Shore/Long Island Jewish, Department of Surgery, 300 Community Drive, Manhasset NY 11030, USA. Electronic address: Cnofi@northwell.edu.
² Northwell North Shore/Long Island Jewish, Department of Surgery, 300 Community Drive, Manhasset NY 11030, USA.
³ Northwell North Shore/Long Island Jewish, Department of Surgery, 300 Community Drive, Manhasset NY 11030, USA; Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead NY 11548, USA.
⁴ Cohen Children's Medical Center, Division of Pediatric General, Thoracic, and Endoscopic Surgery, 269-01 76th Avenue, Queens NY 11040, USA; Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead NY 11548, USA.

PMID: 37903675
DOI: 10.1016/j.jpedsurg.2023.09.042

Abstract

Background: Although management guidelines in adult rectal cancer are widely studied, no consensus guidelines exist for the management of pediatric and young adult rectal cancer.

Methods: The National Cancer Database (2004-2018) was queried for pediatric (age 0-21) and young adult (age 22-40) patients with rectal cancer. Patients were analyzed for receipt of National Comprehensive Cancer Network (NCCN) guideline-concordant therapy. Impact on survival was evaluated using Cox regression and Kaplan-Meier analysis.

Results: 6655 patients (108 pediatric and 6547 young adult patients) with rectal cancer were included. Similar to previously published NCCN quality measures with overall guideline concordance approaching 90 % in adults, 89.6 % of pediatric and 84.6 % of young adult patients were classified as receiving pre-operative guideline-concordant therapy. However, pediatric patients were significantly less likely to receive post-operative guideline-concordant therapy than young adult patients (65.3 % verse 76.7 %, respectively, p = 0.008). Risk of death was significantly lower for pediatric patients who received post-operative guideline-concordant therapy (HR, 0.313; CI, 0.168-0.581; p < 0.001). In young adult patients, risk of death was significantly lower for those who received pre-operative guideline-concordant therapy (HR, 0.376, CI 0.338-0.417, p < 0.001), and post-operative guideline-concordant therapy (HR, 0.456; CI 0.413-0.505; p < 0.001).

Discussion: NCCN-based guidelines may reasonably guide peri-operative management decisions and improve survival in pediatric and young adult rectal cancer. Given the rarity of this cancer in young patients, employment of an experienced surgical and oncologic multidisciplinary team, along with discussion and involvement of the patient and family, are keys for balancing risks and benefits to offering the best therapeutic strategy.

Type of study: Retrospective.

Level of evidence: Level III.

Keywords: Guidelines; NCCN; Pediatric; Rectal cancer.

MeSH terms

Adolescent
Adult
Child
Child, Preschool
Guideline Adherence
Humans
Infant
Infant, Newborn
Kaplan-Meier Estimate
Neoplasm Staging
Rectal Neoplasms* / surgery
Retrospective Studies
Young Adult