Is age just a number? Causal modeling of recurrence risk in rectal cancer.
- 1Surgery Unit, Phatthalung Hospital, Phatthalung, Thailand
- 2Clinical Surgical Research Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- 3Colorectal Surgery Unit, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
Abstract
Purpose
Young-onset rectal cancer (YORC) is increasingly common and often presents with aggressive histological features; however, its effect on recurrence remains uncertain. This study aimed to estimate the causal effect of age at diagnosis on recurrence in patients with rectal cancer using advanced causal inference methods.Methods
This multicenter retrospective cohort study was conducted at 2 university hospitals in Thailand. Patients diagnosed with rectal adenocarcinoma between 2013 and 2022 who underwent curative-intent treatment were included. The primary exposure was age at diagnosis, categorized as YORC (<50 years) or late-onset rectal cancer (LORC; ≥50 years). Confounders were prespecified using a directed acyclic graph and addressed using a confounder composite score. Age was also modeled as a continuous variable using natural splines. The primary outcome was cancer recurrence.Results
Among 585 patients, 116 (19.8%) had YORC and 469 (80.2%) had LORC. Patients with YORC had fewer comorbidities but more unfavorable histological features than those with LORC. Overall, recurrence occurred in 40.2% of patients and most commonly involved distant metastasis. The estimated average causal effect of age on recurrence was -6.5% (95% confidence interval, -16.6% to 3.5%; P=0.202), indicating that younger age was not associated with an increased risk of recurrence, although a protective effect was not confirmed. Natural spline modeling indicated a nonlinear increase in recurrence hazard with advancing age.Conclusion
Younger age at diagnosis was not associated with worse recurrence outcomes despite adverse pathological features, and a potential protective association could not be excluded.
Related
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- Local Recurrence and Oncological Outcomes After Transanal Total Mesorectal Excision With Intersphincteric Resection for Lower Rectal Cancer: A Nationwide Multicenter Cohort Study (Ta‐Ta‐Mi Study)
- Pathomic Texture Composites from H&E, and Immunohistochemistry of Prostatectomy Specimens for Exploratory Modeling of Time to Biochemical Recurrence
- Oncological outcomes of direct versus delayed surgery after neoadjuvant short-course radiotherapy for rectal cancer: national cohort study
- Quality of Life After Organ Preservation in Rectal Cancer—Beyond Survival
BibTeX
@article{tantinam2026just,
title = {{Is age just a number? Causal modeling of recurrence risk in rectal cancer.}},
author = {Thanat Tantinam and Pawit Sutharat and Suwan Sanmee and Ekkarin Supatrakul and Jiraporn Khorana and Sunhawit Junrungsee and Kullawat Bhatanaprabhabhan and Boonchai Ngamsirimas and Nataphon Santrakul and Rangsima Thiengthiantham and Punnawat Chandrachamnong and Apichat Tantraworasin},
journal = {Annals of coloproctology},
year = {2026},
month = oct,
doi = {10.3393/ac.2026.00171.0024},
url = {https://europepmc.org/article/MED/42958778},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Is age just a number? Causal modeling of recurrence risk in rectal cancer.
AU - Thanat Tantinam
AU - Pawit Sutharat
AU - Suwan Sanmee
AU - Ekkarin Supatrakul
AU - Jiraporn Khorana
AU - Sunhawit Junrungsee
AU - Kullawat Bhatanaprabhabhan
AU - Boonchai Ngamsirimas
AU - Nataphon Santrakul
AU - Rangsima Thiengthiantham
AU - Punnawat Chandrachamnong
AU - Apichat Tantraworasin
PY - 2026
DA - 2026/10/27
JO - Annals of coloproctology
DO - 10.3393/ac.2026.00171.0024
UR - https://europepmc.org/article/MED/42958778
AB - Purpose Young-onset rectal cancer (YORC) is increasingly common and often presents with aggressive histological features; however, its effect on recurrence remains uncertain. This study aimed to estimate the causal effect of age at diagnosis on recurrence in patients with rectal cancer using advanced causal inference methods.Methods This multicenter retrospective cohort study was conducted at 2 university hospitals in Thailand. Patients diagnosed with rectal adenocarcinoma between 2013 and 2022 who underwent curative-intent treatment were included. The primary exposure was age at diagnosis, categorized as YORC (<50 years) or late-onset rectal cancer (LORC; ≥50 years). Confounders were prespecified using a directed acyclic graph and addressed using a confounder composite score. Age was also modeled as a continuous variable using natural splines. The primary outcome was cancer recurrence.Results Among 585 patients, 116 (19.8%) had YORC and 469 (80.2%) had LORC. Patients with YORC had fewer comorbidities but more unfavorable histological features than those with LORC. Overall, recurrence occurred in 40.2% of patients and most commonly involved distant metastasis. The estimated average causal effect of age on recurrence was -6.5% (95% confidence interval, -16.6% to 3.5%; P=0.202), indicating that younger age was not associated with an increased risk of recurrence, although a protective effect was not confirmed. Natural spline modeling indicated a nonlinear increase in recurrence hazard with advancing age.Conclusion Younger age at diagnosis was not associated with worse recurrence outcomes despite adverse pathological features, and a potential protective association could not be excluded.
SN - 2287-9714
SN - 2287-9722
ER -