Tomoki Yamano1, Shinichi Yamauchi2, Kei Kimura3, Akihito Babaya4, Michiko Hamanaka5, Masayoshi Kobayashi6, Miki Fukumoto7, Kiyoshi Tsukamoto8, Masafumi Noda9, Naohiro Tomita10, Kenichi Sugihara11. 1. Division of Lower GI Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan. Electronic address: yamanot@hyo-med.ac.jp. 2. Division of Colorectal Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: s-yamauchi.srg2@tmd.ac.jp. 3. Division of Lower GI Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan. Electronic address: k-kimura@hyo-med.ac.jp. 4. Division of Lower GI Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan. Electronic address: bababa7@hyo-med.ac.jp. 5. Division of Lower GI Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan. Electronic address: michiko_hamanaka1023@yahoo.co.jp. 6. Division of Lower GI Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan. Electronic address: oz86.kurumi@gmail.com. 7. Division of Lower GI Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan. Electronic address: mi-fukumoto@hyo-med.ac.jp. 8. Division of Lower GI Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan. Electronic address: tsuka25@hyo-med.ac.jp. 9. Division of Lower GI Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan. Electronic address: noda2s@hyo-med.ac.jp. 10. Division of Lower GI Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan. Electronic address: ntomita@hyo-med.ac.jp. 11. Division of Colorectal Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: k-sugi.srg2@tmd.ac.jp.
Abstract
BACKGROUND: Adjuvant therapy for colorectal cancer (CRC) in patients aged ≥75 years is supported by inadequate evidence, although such patients are increasing in number worldwide. PATIENTS AND METHODS: We assessed the influence of age and comorbidities on the prognosis of CRC in elderly patients using pooled data by the Japanese Study Group for Postoperative Follow-up of Colorectal Cancer. In total, 4598 patients (3304 with colon cancer and 1294 with rectal cancer) who underwent curative surgery from 2004 to 2006 were analysed with respect to age, Charlson comorbidity score (CS), tumour marker positivity, adjuvant therapy and prognosis. RESULTS: The number of patients aged <64, 65-74 and >75 years was 2007 (44%), 1614 (35%) and 977 (21%), respectively. Tumour location, tumour marker positivity, clinical stage, performance of adjuvant therapy, CS and overall survival (OS) were significantly different among these age groups (P < 0.0001). Among patients aged ≥75 years with stage III CRC, 35% with colon cancer and 21% with rectal cancer received adjuvant therapy; these proportions were much lower than those in younger patients. Application of adjuvant therapy was dependent on the CS in patients aged ≤74 years, but not in older patients. Sex, the carcinoembryonic antigen concentration and adjuvant therapy were significantly associated with OS in elderly patients with stage III CRC. CONCLUSION: Age and comorbidities worsened the OS of patients with CRC who underwent curative surgery. However, patients aged ≥75 years were undertreated regardless of their CS despite the possibility of OS improvement by adjuvant therapy.
BACKGROUND: Adjuvant therapy for colorectal cancer (CRC) in patients aged ≥75 years is supported by inadequate evidence, although such patients are increasing in number worldwide. PATIENTS AND METHODS: We assessed the influence of age and comorbidities on the prognosis of CRC in elderly patients using pooled data by the Japanese Study Group for Postoperative Follow-up of Colorectal Cancer. In total, 4598 patients (3304 with colon cancer and 1294 with rectal cancer) who underwent curative surgery from 2004 to 2006 were analysed with respect to age, Charlson comorbidity score (CS), tumour marker positivity, adjuvant therapy and prognosis. RESULTS: The number of patients aged <64, 65-74 and >75 years was 2007 (44%), 1614 (35%) and 977 (21%), respectively. Tumour location, tumour marker positivity, clinical stage, performance of adjuvant therapy, CS and overall survival (OS) were significantly different among these age groups (P < 0.0001). Among patients aged ≥75 years with stage III CRC, 35% with colon cancer and 21% with rectal cancer received adjuvant therapy; these proportions were much lower than those in younger patients. Application of adjuvant therapy was dependent on the CS in patients aged ≤74 years, but not in older patients. Sex, the carcinoembryonic antigen concentration and adjuvant therapy were significantly associated with OS in elderly patients with stage III CRC. CONCLUSION: Age and comorbidities worsened the OS of patients with CRC who underwent curative surgery. However, patients aged ≥75 years were undertreated regardless of their CS despite the possibility of OS improvement by adjuvant therapy.
Authors: Marcin Zeman; Marek Czarnecki; Ewa Chmielik; Adam Idasiak; Władysław Skałba; Mirosław Strączyński; Piotr J Paul; Agnieszka Czarniecka Journal: World J Surg Oncol Date: 2021-05-21 Impact factor: 2.754
Authors: Clark DuMontier; Kah Poh Loh; Paul A Bain; Rebecca A Silliman; Tammy Hshieh; Gregory A Abel; Benjamin Djulbegovic; Jane A Driver; William Dale Journal: J Clin Oncol Date: 2020-04-06 Impact factor: 50.717