Higher local recurrence as the distinct failure pattern in early-onset rectal cancer: a tailored MRI score to guide therapy
The unique biology of early-onset locally advanced rectal cancer (EOLARC) may drive distinct failure patterns, challenging current age-agnostic management. This multicenter retrospective study aimed to define these patterns compared to late-onset disease (LOLARC) and develop a tailored magnetic resonance imaging (MRI)-based risk score. We analyzed 1289 patients undergoing neoadjuvant chemoradiotherapy and surgery. After propensity score matching, EOLARC patients exhibited higher local recurrence rates (4.9% vs. 1.7%; P = 0.03) despite similar pathological complete response (pCR) rates (25.5% vs. 21.2%; P = 0.22). The novel mrTML score (incorporating tumor deposits, mesorectal fascia, and lateral lymph nodes) effectively predicted local recurrence (adjusted hazard ratio for score 3 vs. 0, 33.99). Notably, high pre-treatment risk persisted even among patients achieving pCR (HR 12.02; P = 0.003), highlighting failure patterns uncaptured by pathological response. The mrTML score is a robust tool to identify patients at high risk for local recurrence, providing an evidence-based framework for risk-adapted therapy.
Authors
- Zhong Min’er
- Haitao Huang (ORCID: https://orcid.org/0000-0002-3861-2702)
- C H LIANG
- Yanfen Cui (ORCID: https://orcid.org/0000-0001-7760-7503)
- Wei Xu (ORCID: https://orcid.org/0000-0002-9982-6982)
- Kaibo Ouyang (ORCID: https://orcid.org/0000-0002-1005-119X)
- Yulin Liu (ORCID: https://orcid.org/0000-0003-0273-0296)
- Feng Li (ORCID: https://orcid.org/0000-0003-4252-2854)
- Minning Zhao (ORCID: https://orcid.org/0000-0002-7878-666X)
- Ke Zhao (ORCID: https://orcid.org/0000-0002-1570-6407)
- Yunrui Ye
- Yong Li
- Zhenhui Li
- Lifen Yan
- Zaiyi Liu
Institutions
- Sun Yat-sen University (CN)
- Shanxi Medical University (CN)
- Kunming Medical University (CN)
- Ji Hua Laboratory (CN)
- Sixth Affiliated Hospital of Sun Yat-sen University (CN)
- Key Laboratory of Guangdong Province (CN)
- Zhujiang Hospital (CN)
- Guangdong Academy of Medical Sciences (CN)
- Sun Yat-sen University Cancer Center (CN)
- Guangdong Provincial People's Hospital (CN)
- Southern Medical University (CN)
- South China University of Technology (CN)
Publication Details
- Journal
- npj Precision Oncology
- Published
- 2025-12-24
- DOI
- https://doi.org/10.1038/s41698-025-01244-6
- Primary Topic
- Colorectal Cancer Surgical Treatments
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- National Science Foundation
- National Natural Science Foundation of China
- National Science and Technology Major Project