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Inflammation-based prognostic scores in geriatric patients with rectal cancer. Tech Coloproctol 2022; 27:397-405. [PMID: 36197565 DOI: 10.1007/s10151-022-02710-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/27/2022] [Indexed: 10/10/2022]
Abstract
BACKGROUND Morbidity/mortality and oncologic outcomes can be worsened in geriatric rectal cancer patients due to comorbidities and frailty. The aim of this study was to compare surgical and oncological results of geriatric rectal cancer patients using inflammation-based prognostic scores. METHODS The prospectively maintained database of 991 rectal cancer patients treated at our center between 2007 and 2020 were analyzed. All conventional clinicopathologic features, and oncologic outcomes are compared between patients ≥ 65 years old (geriatric patients: Group I) and < 65 years old (non-geriatric patients: Group II). The modified Glasgow Prognostic Score (mGPS) and the C-reactive protein-albumin ratio (CAR), were determined. The prognostic value of mGPS and CAR as well as the well-known clinico-pathologic factors to predict surgical morbidity, mortality, local and/or distant recurrence, and overall survival was assessed. RESULTS There were 567 (57.2%) patients who were ≥ 65 years old (Group I; 349 males, median age 74 [range 65-9]) years) and 424 (42.8%) who were < 65 years old (Group II; 252 males, median age 58 [range 20-64] years). The high-grade [Clavien-Dindo III-IV] complications rates of Group I and Group II patients sere 20% (n = 113), and 9% (n = 37), respectively. High-grade complications were related to mGPS (p < 0.001) and CAR (p < 0.001) values. The high-grade complication rate was found to be higher in Group I than in Group II, and this was statistically significant (p < 0.001). High preoperative mGPS and CAR values were significantly associated with postoperative mortality (p < 0.001). In Cox multivariate analysis, mGPS (p = 0.003) and CAR (p = 0.001) were significantly in correlation with lowered overall survival. The mGPS and CAR were found to be independent prognostic factors for overall survival. CONCLUSIONS The mGPS and CAR can predict severe postoperative complications and early mortality. mGPS, and CAR have a powerful prognostic value and the potential clinical usefulness to predict decreased overall survival in both geriatric and non-geriatric rectal cancer patients.
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Moureau-Zabotto L, Gal J, Resbeut M, Mineur L, Teissier É, Hébuterne X, Muyldermans P, Francois É, Chamorey E, Gérard JP. [Management and clinical outcome in patients over 80 years with rectal cancer treated between 2006 and 2008 in Southern France (PACA region)]. Cancer Radiother 2015; 19:725-32. [PMID: 26548601 DOI: 10.1016/j.canrad.2015.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 05/19/2015] [Accepted: 05/22/2015] [Indexed: 11/15/2022]
Abstract
PURPOSE Rectal cancer is increasingly prevalent in elderly patients. Their clinical history and outcome after treatment are poorly described. This retrospective study was undertaken to provide more data and to compare therapeutic strategies to the standard of care for younger patients. PATIENTS AND METHODS Patients concerned were aged 80 years or older, with a rectal cancer diagnosed between 2006 and 2008 and treated in Provence-Alpes-Côte-d'Azur (PACA), irrespective of stage and treatment of the disease. Overall survival and relapse-free-survival were correlated with patients' characteristics and treatment. The adopted therapeutic strategy was then compared to the standard-of-care for younger patients. RESULTS With a median follow-up of 36 months, among the 160 patients included, the 3-year overall survival and relapse-free survival were 59.2% and 76.6%, respectively for the 117 patients who received a treatment with curative intent. In the multivariate analysis, node status and surgery independently influenced overall survival, while relapse-free survival was influenced by age, N status, and gender. For T0-T2 tumours, patients were treated similarly to younger patients with an overall survival of 83.6% and a relapse-free survival of 95.2%. For T3-T4 tumours, the 3-year relapse-free survival was 65%, even with a less aggressive strategy. CONCLUSION Surgical resection after evaluation using the Comprehensive Geriatric Assessment (CGA) test should be the standard treatment for localized rectal cancer (T0-T2) in elderly patients, as it is in younger patients. For locally advanced lesions (T3-T4), results obtained after a conservative approach suggest that a non-surgical strategy can be used in elderly patients.
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Affiliation(s)
- L Moureau-Zabotto
- Département de radiothérapie, institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France.
| | - J Gal
- Département de biostatistiques, centre Antoine-Lacassagne, 133, avenue de Valombrose, 06189 Nice, France
| | - M Resbeut
- Département de radiothérapie, institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Centre de radiothérapie Saint-Louis, Croix-Rouge française, rue André-Blondel, 83100 Toulon, France
| | - L Mineur
- Service d'oncologie-radiothérapie, institut Sainte-Catherine, 250, chemin de Baigne-Pieds, CS 800005, 84918 Avignon cedex 9, France
| | - É Teissier
- Centre azuréen de cancérologie, 1, place Docteur-Jean-Luc-Broquerie, 06250 Mougins, France
| | - X Hébuterne
- Service de gastro-entérologie, centre hospitalier universitaire de Nice, 151, route Saint-Antoine-de-Ginestière, 06202 Nice, France
| | - P Muyldermans
- Centre de radiothérapie du Pays-d'Aix, avenue Henri-Pontier, 13100 Aix-en Provence, France
| | - É Francois
- Département d'oncologie médicale, centre Antoine-Lacassagne, 133, avenue de Valombrose, 06189 Nice, France
| | - E Chamorey
- Centre de radiothérapie Saint-Louis, Croix-Rouge française, rue André-Blondel, 83100 Toulon, France
| | - J-P Gérard
- Département de radiothérapie, centre Antoine-Lacassagne, 133, avenue de Valombrose, 06189 Nice, France
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Moureau-Zabotto L, Resbeut M, Gal J, Mineur L, Teissier E, Hebuterne X, Muyldermans P, Francois E, Chamorey E, Gerard JP. Management and clinical outcome of rectal cancer in patients ≥80 years treated in southern France (PACA region) between 2006 and 2008. J Surg Oncol 2013; 108:450-6. [DOI: 10.1002/jso.23428] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 08/10/2013] [Indexed: 11/11/2022]
Affiliation(s)
| | - M. Resbeut
- Departement de Radiotherapie; Institut Paoli Calmettes; France
- Croix Rouge Francaise, Centre de Radiothérapie Saint Louis; Toulon France
| | - J. Gal
- Centre Antoine Lacassagne; Nice France
| | - L. Mineur
- Institut Sainte Catherine; Avignon France
| | - E. Teissier
- Centre Azureen de Cancérologie; Mougins France
| | | | - P. Muyldermans
- Centre de Radiotherapie du Pays d'Aix; Aix-en-Provence France
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Leo S, Accettura C, Gnoni A, Licchetta A, Giampaglia M, Mauro A, Saracino V, Carr BI. Systemic treatment of gastrointestinal cancer in elderly patients. J Gastrointest Cancer 2013; 44:22-32. [PMID: 23150086 DOI: 10.1007/s12029-012-9447-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Gastrointestinal cancer (GI) incidence increases with each decade of life and is the leading cause of death in patients aged >70 years. Nevertheless, elderly patients are often excluded or underrepresented in clinical trials. We performed a review of current recommendations in the management of GI elderly cancer patients. METHODS A comprehensive literature review was performed analyzing data about several meta-analysis and studies regarding chemotherapeutic regimens in elderly patients with colorectal and gastroesophageal cancers. RESULTS Most of the studies demonstrated that the elderly experience the same advantages and toxicities from chemotherapy as younger individuals despite the fact that the data reviewed in this article provide evidence that elderly with GI cancers are underrepresented in clinical trials and few trials are conducted addressing the different risks and aims in older population. Each individual should be assessed for an appropriate regimen of treatment in the adjuvant or metastatic gastrointestinal cancer setting, and the decision of how to treat elderly must incorporate goals and preferences of the patient after a careful discussion of risks and benefits. CONCLUSION Chronological age alone is not a sufficient factor to withhold curative/palliative treatment from an elderly GI cancer patient, and cofactors regarding their functional, social, and mental status have to be considered. For this purpose, several tools exist that may be utilized, such as geriatric assessment scores, comorbidity indices, frailty indices, scores for predicting toxicity from chemotherapy, and prognostic indices for survival.
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Affiliation(s)
- Silvana Leo
- Geriatric Oncology Unit-Medical Oncology Department, Vito Fazzi Hospital, Lecce, Italy.
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Le Fur E, Chatellier G, Berger A, Emile JF, Dousset B, Nordlinger B, Berges O, Deberne M, Dessard-Diana B, Henni M, Giraud P, Housset M, Durdux C. [Tolerance and efficacy of preoperative radiation therapy for elderly patients treated for rectal cancer]. Cancer Radiother 2013; 17:202-7. [PMID: 23643361 DOI: 10.1016/j.canrad.2013.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 12/22/2012] [Accepted: 01/31/2013] [Indexed: 01/09/2023]
Abstract
PURPOSE To retrospectively assess the impact of age on tolerance and oncologic outcomes treated by neoadjuvant treatment for patients of 70 years old or above with locally advanced rectal cancer. PATIENTS AND METHODS Ninety-one consecutive patients were divided into three groups: group 1 from 70 to 75 years (n=31); group 2: 76 to 79 years (n=31) and group 3, patients aged 80 years or above (n=29). Radiation therapy was delivered according two schemes: 25Gy in five fractions (short scheme) or 45 to 50Gy with a classical fractionation (long scheme). Long scheme patients received a concomitant chemotherapy with 5-fluoro-uracile alone or associated with oxaliplatin. RESULTS The three groups were comparable for performance status, Charlson's score and T staging. Long scheme radiation therapy and chemotherapy were performed in 77.5, 74.5 and 48.3% of patients (P=0.03) and 77.4, 71 and 41.4% (P=0.006) in the groups 1, 2 and 3, respectively. All patients treated with the short scheme irradiation received the treatment without any acute toxicity. In the long scheme group, 65% of patients received the treatment on time and grade 3 or above toxicity was observed in 12% of patients who did not receive oxaliplatin and in 48% of patients who received oxaliplatin. The overall survival rate at 3 and 5 years was 66.9% and 60.8% in the group 1, 90.5% and 75.9% in the group 2 and 80.5% and 73.8% in the group 3 (P=0.15). CONCLUSION Neoadjuvant treatment is feasible with encouraging survival rates for patients aged 70 years and older. Short scheme radiation therapy seems to be an interesting option in this population.
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Affiliation(s)
- E Le Fur
- Service de radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
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