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Wang W, Shen T, Wang J. Analysis of the impact of radiotherapy and surgical treatment regimens based on the SEER database on the survival outcomes of rectal cancer patients over 70 years. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2024; 21:4463-4484. [PMID: 38549336 DOI: 10.3934/mbe.2024197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
OBJECTIVE This study evaluates the impact of different combinations of treatment regimens, such as additional radiation, chemotherapy, and surgical treatments, on the survival of elderly rectal cancer patients ≥ 70 years of age to support physicians' clinical decision-making. METHODS Data from a sample of elderly rectal cancer patients aged ≥ 70 years diagnosed from 2005-2015 from the US surveillance, epidemiology, and end results (SEER) database were retrospectively analyzed. The best cut-off point was selected using the x-tile software for the three continuity indices: age, tumor size, and number of regional lymph nodes. All patients were categorized into either the neoadjuvant radiotherapy and surgery group (R_S group), the surgical treatment group (S group), or the surgery and adjuvant radiotherapy group (S_R group). The propensity score allocation was used to match each included study subject in a 1:1 ratio, and the restricted mean survival time method (RMST) was used to predict the mean survival of rectal cancer patients within 5 and 10 years. The prognostic risk factors for rectal cancer patients were determined using univariate and multivariate Cox regression analyses, and nomograms were constructed. A subgroup stratification analysis of patients with different treatment combination regimens was performed using the Kaplan-Meier method, and log-rank tests were used for between-group comparisons. The model's predictive accuracy was assessed by receiver operating characteristic (ROC) curves, correction curves, and a clinical decision curve analysis (DCA). RESULTS A total of 7556 cases of sample data from 2005 to 2015 were included, which were categorized into 6639 patients (87.86%) in the S group, 408 patients (5.4%) in the R_S group, and 509 patients (6.74%) in the S_R group, according to the relevant order of radiotherapy and surgery. After propensity score matching (PSM), the primary clinical characteristics of the groups were balanced and comparable. The difference in the mean survival time before and after PSM was not statistically significant in both R_S and S groups (P value > 0.05), and the difference in the mean survival time after PSM was statistically substantial in S_R and S groups (P value < 0.05). In the multifactorial Cox analysis, the M1 stage and Nodes ≥ 9 were independent risk factors. An age between 70-75 was an independent protective factor for patients with rectal cancer in the R_S and S groups. The Marital_status, T4 stage, N2 stage, M1 stage, and Nodes ≥ 9 were independent risk factors for patients with rectal cancer in the S_R and S groups, and an age between 70-81 was an independent protective factor. The ROC curve area, the model C index, and the survival calibration curve suggested good agreement between the actual and predicted values of the model. The DCA for 3-year, 5-year, and 10-year survival periods indicated that the model had some potential for application. CONCLUSIONS The results of the study showed no significant difference in the overall survival (OS) between elderly patients who received neoadjuvant radiotherapy and surgery and those who received surgery alone; elderly patients who received surgery and adjuvant radiotherapy had some survival benefits compared with those who received surgery alone, though the benefit of adjuvant radiotherapy was not significant. Therefore, radiotherapy for rectal cancer patients older than 70 years old should be based on individual differences in condition, and a precise treatment plan should be developed.
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Affiliation(s)
- Wei Wang
- The First Affiliated Hospital, Anhui University of Chinese Medicine, Hefei, China
| | - Tongping Shen
- School of Information Engineering, Anhui University of Chinese Medicine, Hefei, China
- Graduate School, Angeles University Foundation, Angeles, Philippines
| | - Jiaming Wang
- School of Information Engineering, Anhui University of Chinese Medicine, Hefei, China
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2
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Normann M, Ekerstad N, Angenete E, Prytz M. Mortality and morbidity after colorectal cancer resection surgery in elderly patients: a retrospective population-based study in Sweden. World J Surg Oncol 2024; 22:23. [PMID: 38254209 PMCID: PMC10802062 DOI: 10.1186/s12957-024-03316-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Colorectal cancer is primarily a condition of older adults, and surgery is the cornerstone of treatment. As life expectancy is increasing and surgical techniques and perioperative care are developing, curative surgery is often conducted even in ageing populations. However, the risk of morbidity, functional decline, and mortality following colorectal cancer resection surgery are known to increase with increasing age. This study aims to describe real-world data about postoperative mortality and morbidity after resection surgery for colorectal cancer in the elderly (≥ 70 years) compared to younger patients (< 70 years), in a Swedish setting. METHODS A cohort study including all patients diagnosed with colorectal cancer in a Swedish region of 1.7 million inhabitants between January 2016 and May 2020. Patients were identified through the Swedish Colorectal Cancer Registry, and all baseline and outcome variables were extracted from the registry. The following outcome measures were compared between the two age groups: 90-day mortality rates, postoperative complications, postoperative intensive care, reoperations, readmissions, and 1-year mortality. To adjust the analyses for baseline confounders in the comparison of the outcome variables, the following methods were used: marginal matching, calliper (ID matching), and logistic regression adjusted for baseline confounders. RESULTS The cohort consisted of 5246 patients, of which 3849 (73%) underwent resection surgery. Patients that underwent resection surgery were significantly younger than those who did not (mean ± SD, 70.9 ± 11.4 years vs 73.7 ± 12.8 years, p < 0.001). Multivariable analyses revealed that both 90-day and 1-year mortality rates were higher in older patients that underwent resection surgery (90-day mortality OR 2.12 [95% CI 1.26-3.59], p < 0.005). However, there were no significant differences in postoperative intensive care, postoperative complications, reoperations, or readmissions. CONCLUSION Elderly patients suffer increased postoperative mortality after resection surgery for colorectal cancer compared to younger individuals. Given the growing elderly population that will continue to require surgery for colorectal cancer, more efficient ways of determining and handling individual risk for older adults need to be implemented in clinical practice.
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Grants
- VGFOUREG-940671 Department of Research and Development, Västra Götalandsregionen, Sweden
- VGFOUREG-940671 Department of Research and Development, Västra Götalandsregionen, Sweden
- VGFOUREG-940671 Department of Research and Development, Västra Götalandsregionen, Sweden
- VGFOUREG-940671 Department of Research and Development, Västra Götalandsregionen, Sweden
- VGFOUFBD-937668 Department of Research and Development, Fyrbodal, Sweden
- VGFOUFBD-937668 Department of Research and Development, Fyrbodal, Sweden
- VGFOUFBD-937668 Department of Research and Development, Fyrbodal, Sweden
- VGFOUFBD-937668 Department of Research and Development, Fyrbodal, Sweden
- University of Gothenburg
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Affiliation(s)
- Maria Normann
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Surgery, Region Västra Götaland, NU-Hospital Group, Trollhättan, Sweden.
| | - Niklas Ekerstad
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Research and Development, Region Västra Götaland, NU-Hospital Group, Trollhättan, Sweden
| | - Eva Angenete
- Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mattias Prytz
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Region Västra Götaland, NU-Hospital Group, Trollhättan, Sweden
- Department of Research and Development, Region Västra Götaland, NU-Hospital Group, Trollhättan, Sweden
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3
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Guo C, Pan J, Tian S, Gao Y. Using machine learning algorithms to predict 28-day mortality in critically ill elderly patients with colorectal cancer. J Int Med Res 2023; 51:3000605231198725. [PMID: 37950672 PMCID: PMC10640810 DOI: 10.1177/03000605231198725] [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: 02/26/2023] [Accepted: 08/16/2023] [Indexed: 11/13/2023] Open
Abstract
OBJECTIVE To predict the 28-day mortality of critically ill, elderly patients with colorectal cancer (CRC) using five machine learning approaches. METHODS Data were extracted from the eICU Collaborative Research Database (eICU-CRD) (version 2.0) for a training cohort and from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) and Wuhan Union hospital for validation cohorts. Clinical information (i.e., demographics; initial laboratory tests; vital signs; outcomes) were collected. Five machine learning algorithms (LightGBM, decision tree, XGBoost, random forest, and ensemble model) and a logistic regression were applied for the prediction of 28-day mortality. RESULTS Overall, 693 patients were included from the eICU cohort, 181 patients from the MIMIC-IV cohort and 95 from the Wuhan Union cohort. Among the six machine learning models, the ensemble model exhibited the best predictive ability (AUC, 0.86), followed by random forest (AUC, 0.83) and LightGBM (AUC, 0.82) in the training cohort. The models also obtained the good predictive performance for the 28-day mortality in the validation cohorts. CONCLUSIONS We showed that machine learning algorithms can be used for the 28-day mortality prediction in critically ill, elderly patients with CRC.
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Affiliation(s)
- Chunxia Guo
- Department of Infectious Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jun Pan
- Department of Gastroenterology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
| | - Shan Tian
- Department of Infectious Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yuanjun Gao
- Department of Gastroenterology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
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4
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Zhou Y, Shao Y, Hu W, Zhang J, Shi Y, Kong X, Jiang J. A novel long noncoding RNA SP100-AS1 induces radioresistance of colorectal cancer via sponging miR-622 and stabilizing ATG3. Cell Death Differ 2023; 30:111-124. [PMID: 35978049 PMCID: PMC9883267 DOI: 10.1038/s41418-022-01049-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 02/01/2023] Open
Abstract
Although radiotherapy is an essential modality in the treatment of colorectal cancer (CRC), the incidence of radioresistance remains high clinically. Long noncoding RNAs (lncRNAs) reportedly play critical roles in CRC radioresistance by regulating genes or proteins at the transcriptional or post-translational levels. This study aimed to identify novel lncRNAs involved in radioresistance. We found that SP100-AS1 (lncRNA targeting antisense sequence of SP100 gene) was upregulated in radioresistant CRC patient tissues using RNA-seq analysis. Importantly, knockdown of SP100-AS1 significantly reduced radioresistance, cell proliferation, and tumor formation in vitro and in vivo. Mechanistically, mass spectrometry and bioinformatics analyses were used to identify the interacting proteins and microRNAs of SP100-AS1, respectively. Moreover, SP100-AS1 was found to interact with and stabilize ATG3 protein through the ubiquitination-dependent proteasome pathway. In addition, it could serve as a sponge for miR-622, which targeted ATG3 mRNA and affected autophagic activity. Thus, lncRNA SP100-AS1 could act as a radioresistance factor in CRC patients via RNA sponging and protein stabilizing mechanisms. In conclusion, the present study indicates that SP100-AS1/miR-622/ATG3 axis contributes to radioresistance and autophagic activity in CRC patients, suggesting it has huge prospects as a therapeutic target for improving CRC response to radiation therapy.
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Affiliation(s)
- You Zhou
- grid.452253.70000 0004 1804 524XTumor Biological Diagnosis and Treatment Center, The Third Affiliated Hospital of Soochow University, Changzhou, 213003 China ,Jiangsu Engineering Research Center for Tumor Immunotherapy, Changzhou, 213003 China ,grid.263761.70000 0001 0198 0694Institute of Cell Therapy, Soochow University, Changzhou, 213003 China
| | - Yingjie Shao
- grid.452253.70000 0004 1804 524XDepartment of Radiation Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003 China
| | - Wenwei Hu
- grid.452253.70000 0004 1804 524XDepartment of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003 China
| | - Jinping Zhang
- grid.263761.70000 0001 0198 0694Institutes of Biology and Medical Sciences, Soochow University, Suzhou, 215123 China
| | - Yufang Shi
- grid.429222.d0000 0004 1798 0228The First Affiliated Hospital of Soochow University, State Key Laboratory of Radiation Medicine and Protection, Institutes for Translational Medicine, Soochow University Medical College, Suzhou, 215123 China
| | - Xiangyin Kong
- grid.9227.e0000000119573309CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Shanghai, 200031 China
| | - Jingting Jiang
- Tumor Biological Diagnosis and Treatment Center, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China. .,Jiangsu Engineering Research Center for Tumor Immunotherapy, Changzhou, 213003, China. .,Institute of Cell Therapy, Soochow University, Changzhou, 213003, China.
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5
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Normann M, Ekerstad N, Angenete E, Prytz M. Effect of comprehensive geriatric assessment for frail elderly patients operated for colorectal cancer—the colorectal cancer frailty study: study protocol for a randomized, controlled, multicentre trial. Trials 2022; 23:948. [PMID: 36397083 PMCID: PMC9670054 DOI: 10.1186/s13063-022-06883-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Colorectal cancer (CRC) is the third most common cancer worldwide, with a median age of 72–75 years at diagnosis. Curative treatment usually involves surgery; if left untreated, symptoms may require emergency surgery. Therefore, most patients will be accepted for surgery, despite of high age or comorbidity. It is known that elderly patients suffer higher risks after surgery than younger patients, in terms of complications and mortality. Assessing frailty and offering frail elderly patients individualized treatment according to the comprehensive geriatric assessment (CGA) and care concept has been shown to improve the outcome for frail elderly patients in other clinical contexts. Methods This randomized controlled multicentre trial aims to investigate if CGA and care prior to curatively intended surgery for CRC in frail elderly patients will improve postoperative outcome. All patients ≥ 70 years with surgically curable CRC will be screened for frailty using the Clinical Frailty Scale (CFS-9). Frail patients will be offered inclusion. Randomization is stratified for colon or rectal cancer. Patients in the intervention group are, in addition to standard protocol, treated according to CGA and care. This consists of individualized assessments and interventions, established by a multiprofessional team. Patients in the control group are treated according to best known practice as stipulated by Swedish colorectal cancer treatment guidelines, within an enhanced recovery after surgery (ERAS) setting. The primary outcome is 90-day mortality. Secondary outcomes are the length of hospital stay and total number of hospital days within 3 months, discharge destination, 30-day readmission, ADL, safe medication assessment, CFS-9 score, complications, Health-Related Quality of Life (HRQoL) at 2-month follow-up in comparison to baseline measurements, health economical calculations including cost-effectiveness analysis based on costs of hospital care and primary care, mortality and HRQoL at baseline, 2- and 12-month follow-up and all-cause 1-year mortality. Discussion The trial is the first of its size and extent to investigate intervention with CGA and care prior to surgery for CRC in frail elderly patients. If this addition proves to be favourable, it could have implications on future care of frail elderly patients with CRC. Trial registration ClinicalTrials.gov NCT04358328. Registered on 4 February 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06883-9.
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Affiliation(s)
- Maria Normann
- grid.8761.80000 0000 9919 9582Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,grid.459843.70000 0004 0624 0259Department of Surgery, Region Västra Götaland, NU-Hospital Group, Trollhättan, Sweden
| | - Niklas Ekerstad
- grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden ,grid.459843.70000 0004 0624 0259Department of Research and Development, Region Västra Götaland, NU-Hospital Group, Trollhättan, Sweden
| | - Eva Angenete
- grid.8761.80000 0000 9919 9582Department of Surgery, SSORG – Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mattias Prytz
- grid.8761.80000 0000 9919 9582Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,grid.459843.70000 0004 0624 0259Department of Surgery, Region Västra Götaland, NU-Hospital Group, Trollhättan, Sweden ,grid.459843.70000 0004 0624 0259Department of Research and Development, Region Västra Götaland, NU-Hospital Group, Trollhättan, Sweden
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6
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Reboux N, Cadieu E, Pruvost-Couvreur M, Cariou M, Kermarrec M, Kermarrec T, Bouzeloc S, Nousbaum JB, Robaszkiewicz M, Quénéhervé L. Factors associated with non-presentation in a multidisciplinary team meeting for colon cancer: A matched retrospective cohort study in a French area. Clin Res Hepatol Gastroenterol 2022; 46:101950. [PMID: 35609825 DOI: 10.1016/j.clinre.2022.101950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/18/2022] [Accepted: 05/04/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Survival of patients with colon cancer has increased in recent years due to advances in treatment and the implementation of multidisciplinary team meetings (MDTm). However, the organization of MDTm can be improved. The objectives of this work were to characterize patients with colon cancer who were not presented in MDTm and to analyse the reasons for their non-presentation. METHODS The study was based on a retrospective cohort including patients with colon cancer diagnosed between 2014 and 2016. Risk factors for non-presentation in MDTm were investigated after 1:1 matching on age, gender and tumour location, using multivariate analysis. RESULTS amongst 1616 patients diagnosed with colon cancer, 20.5% were not presented in MDTm. The most common reasons for non-presentation were 'advanced age or poor general condition' (22.6%) and 'superficial tumour' (20.5%), while 20.8% of non-presentation remained unexplained. Non-presentation in MDTm was associated with ECOG PS of 2 (OR 0.51, 95%CI 0.32-0.81, p = 0.005), best supportive care (OR 0.05, 95%CI 0.00-0.38, p = 0.016) and early death (OR 0.09, 95%CI 0.04-0.19, p<0.001). By contrast, patients with symptomatic tumours were more likely to be presented in MDTm than patients participating in mass screening (OR 2.16, 95%CI 1.09-4.32, p = 0.028). Presentation was significantly associated with diagnosis by a digestive surgeon (OR 2.16, 95%CI 1.22-3.92, p = 0.01) and a high UICC stage. CONCLUSIONS This study identified factors associated with non-presentation in a multidisciplinary team meeting for colon cancer such as an advanced age or a superficial tumour, paving the way for targeted improvements.
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Affiliation(s)
- Noémi Reboux
- Gastroenterology department, University hospital of Brest, 29200 Brest, France.
| | - Estelle Cadieu
- Gastroenterology department, University hospital of Brest, 29200 Brest, France
| | - Manon Pruvost-Couvreur
- Digestive tumour registry of Finistère, Brest University Hospital, 29200 Brest, France; EA 7479 SPURBO, Brest University, Brest, France
| | - Melanie Cariou
- Digestive tumour registry of Finistère, Brest University Hospital, 29200 Brest, France; EA 7479 SPURBO, Brest University, Brest, France
| | - Morgane Kermarrec
- OncoBretagne, 19 Avenue de la Bataille Flandres-Dunkerque, 35000 Rennes, France
| | - Tiphaine Kermarrec
- Digestive tumour registry of Finistère, Brest University Hospital, 29200 Brest, France; EA 7479 SPURBO, Brest University, Brest, France
| | - Servane Bouzeloc
- Digestive tumour registry of Finistère, Brest University Hospital, 29200 Brest, France; EA 7479 SPURBO, Brest University, Brest, France
| | - Jean-Baptiste Nousbaum
- Gastroenterology department, University hospital of Brest, 29200 Brest, France; Digestive tumour registry of Finistère, Brest University Hospital, 29200 Brest, France; EA 7479 SPURBO, Brest University, Brest, France
| | - Michel Robaszkiewicz
- Gastroenterology department, University hospital of Brest, 29200 Brest, France; Digestive tumour registry of Finistère, Brest University Hospital, 29200 Brest, France; EA 7479 SPURBO, Brest University, Brest, France
| | - Lucille Quénéhervé
- Gastroenterology department, University hospital of Brest, 29200 Brest, France.
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7
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Aparicio T, Bouché O, Etienne PL, Barbier E, Mineur L, Desgrippes R, Guérin-Meyer V, Hocine F, Martin J, Le Brun-Ly V, Cretin J, Desramé J, Rinaldi Y, Cany L, Falandry C, Lefevre LB, Marous M, Terrebonne E, Mosser L, Turpin J, Turpin A, Bauguion L, Reichling C, Van den Eynde M, Carola E, Hiret S. Preliminary tolerance analysis of adjuvant chemotherapy in older patients after resection of stage III colon cancer from the PRODIGE 34-FFCD randomized trial. Dig Liver Dis 2022; 55:541-548. [PMID: 36115817 DOI: 10.1016/j.dld.2022.08.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Colon adenocarcinoma mainly occurs in older patients. Oxaliplatin-based adjuvant chemotherapy improved disease-free survival after stage III colon cancer resection, but this improvement was not demonstrated in older patients. METHODS The purpose of ADAGE-PRODIGE 34, randomized open phase III trial is to compare in patients over 70 years oxaliplatin plus fluoropyrimidine with fluoropyrimidine alone in fit patients (Group 1) and fluoropyrimidine with observation in frail patients (Group 2) after resection of stage III colon adenocarcinoma. We report a preliminary tolerance analysis on 50% of the first patients enrolled. RESULTS The analysis was conducted on 491 patients (378 in Group 1 and 113 in Group 2). Patients in Group 2 were older and showed more frailty criteria than those in Group 1. Cumulative grade 3-5 toxicities were more frequent in patients treated with oxaliplatin in Group 1 or with fluoropyrimidine in Group 2 than in patients treated with fluoropyrimidine in Group 1. At least one course was deferred in more than half of the patients in all groups. Early treatment cessation was more frequent in Group 2. CONCLUSION No safety concerns were raised for the continuation of accrual. The frailty criteria distribution suggests that the investigator's evaluation for group allocation was accurate.
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Affiliation(s)
- Thomas Aparicio
- Gastroenterology and Digestive Oncology department, CHU Saint Louis, APHP, Université de Paris Cité, Paris, France.
| | - Olivier Bouché
- Gastroenterology and Digestive Oncology department, Reims, France
| | - Pierre-Luc Etienne
- Centre Armoricain de Radiothérapie, Imagerie, Oncologie, et Hôpital Privé des Côtes d'Armor, Plérin, France
| | - Emilie Barbier
- Biostatistic department, Burgundy University, INSERM U866, Fédération Francophone de Cancérologie Digestive, Dijon, France
| | - Laurent Mineur
- Oncology department, Clinique Saint Catherine, Avignon, France
| | - Romain Desgrippes
- Hepatogastroenterology and Digestive Oncology department, CH Saint-Malo, Saint-Malo, France
| | | | | | - Jean Martin
- Oncology department, Clinique François Chenieux, Limoges, France
| | | | | | | | - Yves Rinaldi
- Hepato Gastroenterology department, Hôpital Européen de Marseille, Marseille, France
| | - Laurent Cany
- Radiotherapy and Oncology department, Polyclinique Francheville, Perigueux, France
| | - Claire Falandry
- Geriatry department CHU Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France; Laboratoire CarMeN de l'Université de Lyon, Inserm U1060, INRA U1397, Université Claude Bernard Lyon 1, INSA Lyon, UCOGIR- Auvergne-Rhône-Alpes Ouest - Guyane
| | | | | | - Eric Terrebonne
- Gastroenterology department, CHU Haut Lévèque, Pessac, France
| | | | | | | | | | | | - Marc Van den Eynde
- Gastroenterology and Digestive Oncology department, Cliniques Universitaires Saint Luc, Bruxelles, Belgium
| | | | - Sandrine Hiret
- Medical Oncology department, Institut Cancérologique de l'Ouest, Saint Herblain, France
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8
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Flood MP, Narasimhan V, Waters PS, Kong JC, Ramsay R, Michael M, Tie J, McCormick JJ, Warrier SK, Heriot AG. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases in an elderly population: outcomes from a single centre. ANZ J Surg 2022; 92:2192-2198. [PMID: 35531885 DOI: 10.1111/ans.17761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The prevalence of elderly patients with resectable colorectal peritoneal metastases (CRPM) is increasing. This study aimed to compare short and long-term outcomes of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for CRPM in patients above and below 70 years of age. METHODS This was a retrospective, 10-year analysis of 90-day major morbidity and mortality, and long-term survival. RESULTS Thirty-two (21.3%) of 150 consecutive patients who underwent CRS and HIPEC during the study period were aged 70 and older. PCI (P = 0.04), perioperative chemotherapy use (P < 0.01) and organ resections (rectum P = 0.04, diaphragm P = 0.03) were less in the over 70 group. There was no significant differences in major morbidity (P = 0.19) and mortality (P = 0.32). There was also no difference in 5-year overall survival (OS) (≥70: 26% vs. <70: 39%; P = 0.68) and disease-free survival (DFS) (≥70: 25% vs. <70: 14%; P = 0.22). Age above 70 was not independently associated with worse OS (HR 1.55, P = 0.20) and DFS (HR 1.07, P = 0.81). CONCLUSION The surgical management of CRPM appears safe and feasible in this elderly population. Appropriate selection of elderly patients for such radical intervention is reinforced by the comparable survival with those under 70.
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Affiliation(s)
- Michael P Flood
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Vignesh Narasimhan
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Peadar S Waters
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Joseph C Kong
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Robert Ramsay
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Michael Michael
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Division of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jeanne Tie
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Division of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jacob J McCormick
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Satish K Warrier
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Alexander G Heriot
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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9
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Takeyama H, Noura S, Suzuki Y, Odagiri K, Yanagimoto Y, Yamashita M, Shimizu J, Kawase T, Imamura H, Iwazawa T, Tomita N, Dono K. Higher Body Mass Index Is a Simple Favorable Non-cancer Prognostic Marker for Japanese Elderly Colorectal Cancer Patients after Curative Resection. J Anus Rectum Colon 2022; 6:134-142. [PMID: 35572483 PMCID: PMC9045859 DOI: 10.23922/jarc.2021-056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives: In elderly colorectal cancer (CRC) patients, preoperative surgical indications can be controversial in some cases depending on the patient's physical condition. In comparison with younger patients, both cancer-specific survival (CSS) and non-CCS (NCSS) have an impact on the prognosis and both CSS and NCSS should be considered in the preoperative assessment. We aimed to investigate the impact of body mass index (BMI) on CSS and NCSS in Japanese elderly CRC patients. Methods: We retrospectively collected data from 471 Japanese elderly patients (≥80 years) with stage I-III CRC who underwent curative surgery from 1998 to 2017. A Kaplan-Meier survival analysis with propensity score matching (PSM) and a multivariate Cox regression analysis were performed. Results: After PSM, 123 higher BMI (≥23) and 123 lower BMI (<23) cases were matched. The higher BMI group had significantly better survival than the lower BMI group regarding NCSS and overall survival (OS; P < .001 and P < .001, respectively). The multivariate survival analysis further confirmed that the higher BMI group had significantly better survival than the lower BMI group regarding CSS, NCSS, and OS (P = .027, P < .001, and P < .001, respectively). Conclusions: In Japanese elderly patients with stage I-III CRC who underwent curative surgery, preoperative higher BMI was a significant and simple favorable prognostic predictor, especially for NCSS and OS.
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Affiliation(s)
| | - Shingo Noura
- Department of Surgery, Toyonaka Municipal Hospital
| | - Yozo Suzuki
- Department of Surgery, Toyonaka Municipal Hospital
| | | | | | | | | | | | | | | | | | - Keizo Dono
- Department of Surgery, Toyonaka Municipal Hospital
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10
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Gullickson C, Goodman M, Joko-Fru YW, Gnangnon FHR, N'Da G, Woldegeorgis MA, Buziba NG, Karugu C, Manraj SS, Lorenzoni CF, Hansen R, Finesse A, Somdyala NIM, Bukirwa P, Chingonzoh T, Chokunonga E, Liu B, Kantelhardt E, Parkin DM, Jemal A. Colorectal cancer survival in sub-Saharan Africa by age, stage at diagnosis and Human Development Index: A population-based registry study. Int J Cancer 2021; 149:1553-1563. [PMID: 34164808 DOI: 10.1002/ijc.33715] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 02/05/2023]
Abstract
There are limited population-based survival data for colorectal cancer (CRC) in sub-Saharan Africa. Here, 1707 persons diagnosed with CRC from 2005 to 2015 were randomly selected from 13 population-based cancer registries operating in 11 countries in sub-Saharan Africa. Vital status was ascertained from medical charts or through next of kin. 1-, 3- and 5-year overall and relative survival rates for all registries and for each registry were calculated using the Kaplan-Meier estimator. Multivariable analysis was used to examine the associations of 5-year relative survival with age at diagnosis, stage and country-level Human Development Index (HDI). Observed survival for 1448 patients with CRC across all registries combined was 72.0% (95% CI 69.5-74.4%) at 1 year, 50.4% (95% CI 47.6-53.2%) at 3 years and 43.5% (95% CI 40.6-46.3%) at 5 years. We estimate that relative survival at 5 years in these registry populations is 48.2%. Factors associated with poorer survival included living in a country with lower HDI, late stage at diagnosis and younger or older age at diagnosis (<50 or ≥70 years). For example, the risk of death was 1.6 (95% CI 1.2-2.1) times higher for patients residing in medium-HDI and 2.7 (95% CI 2.2-3.4) times higher for patients residing in low-HDI compared to those residing in high-HDI countries. Survival for CRC remains low in sub-Saharan African countries, though estimates vary considerably by HDI. Strengthening health systems to ensure access to prevention, early diagnosis and appropriate treatment is critical in improving outcomes of CRC in the region.
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Affiliation(s)
- Cricket Gullickson
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael Goodman
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Yvonne W Joko-Fru
- The African Cancer Registry Network, INCTR African Registry Programme, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Guy N'Da
- Abidjan Cancer Registry, Abidjan, Côte d'Ivoire
| | | | | | | | - Shyam S Manraj
- Mauritius National Cancer Registry, Port Louis, Mauritius
| | | | | | - Anne Finesse
- Seychelles National Cancer Registry, Victoria, Seychelles
| | | | | | | | | | - Biying Liu
- The African Cancer Registry Network, INCTR African Registry Programme, Oxford, UK
| | - Eva Kantelhardt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle, Germany
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Donald M Parkin
- The African Cancer Registry Network, INCTR African Registry Programme, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Cancer Surveillance Unit, International Agency for Research on Cancer, Lyon, France
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11
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Michalopoulou E, Matthes KL, Karavasiloglou N, Wanner M, Limam M, Korol D, Held L, Rohrmann S. Impact of comorbidities at diagnosis on the 10-year colorectal cancer net survival: A population-based study. Cancer Epidemiol 2021; 73:101962. [PMID: 34051687 DOI: 10.1016/j.canep.2021.101962] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/14/2021] [Accepted: 05/12/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND It is established that comorbidities negatively influence colorectal cancer (CRC)-specific survival. Only few studies have used the relative survival (RS) setting to estimate this association, although RS has been proven particularly useful considering the inaccuracy in death certification. This study aimed to investigate the impact of non-cancer comorbidities at CRC diagnosis on net survival, using cancer registry data. METHODS We included 1076 CRC patients diagnosed between 2000 and 2001 in the canton of Zurich. The number and severity of comorbidities was expressed using the Charlson Comorbidity Index (CCI). Multiple imputation was performed to account for missing information and 10-year net survival was estimated by modeling the excess hazards of death due to CRC, using flexible parametric models. RESULTS After imputation, approximately 35 % of the patients were affected by comorbidities. These appeared to decrease the 10-year net survival; the estimated excess hazard ratio for patients with one mild comorbidity was 2.14 (95 % CI 1.60-2.86), and for patients with one more severe or more than one comorbidity was 2.43 (95 % CI 1.77-3.34), compared to patients without comorbidities. CONCLUSIONS Our analysis suggested that non-cancer comorbidities at CRC diagnosis significantly decrease the 10-year net survival. Future studies should estimate net survival of CRC including comorbidities as prognostic factor and use a RS framework to overcome the uncertainty in death certification.
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Affiliation(s)
- Eleftheria Michalopoulou
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland; Cancer Registry Zurich, Zug, Schwyz and Schaffhausen, University Hospital Zurich, Vogelsangstrasse 10, 8091, Zurich, Switzerland
| | - Katarina Luise Matthes
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland; Cancer Registry Zurich, Zug, Schwyz and Schaffhausen, University Hospital Zurich, Vogelsangstrasse 10, 8091, Zurich, Switzerland; Institute of Evolutionary Medicine, University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland
| | - Nena Karavasiloglou
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland; Cancer Registry Zurich, Zug, Schwyz and Schaffhausen, University Hospital Zurich, Vogelsangstrasse 10, 8091, Zurich, Switzerland
| | - Miriam Wanner
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland; Cancer Registry Zurich, Zug, Schwyz and Schaffhausen, University Hospital Zurich, Vogelsangstrasse 10, 8091, Zurich, Switzerland
| | - Manuela Limam
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland; Cancer Registry Zurich, Zug, Schwyz and Schaffhausen, University Hospital Zurich, Vogelsangstrasse 10, 8091, Zurich, Switzerland
| | - Dimitri Korol
- Cancer Registry Zurich, Zug, Schwyz and Schaffhausen, University Hospital Zurich, Vogelsangstrasse 10, 8091, Zurich, Switzerland
| | - Leonhard Held
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Sabine Rohrmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland; Cancer Registry Zurich, Zug, Schwyz and Schaffhausen, University Hospital Zurich, Vogelsangstrasse 10, 8091, Zurich, Switzerland.
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12
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Impact of Age and Comorbidity on Multimodal Management and Survival from Colorectal Cancer: A Population-Based Study. J Clin Med 2021; 10:jcm10081751. [PMID: 33920665 PMCID: PMC8073362 DOI: 10.3390/jcm10081751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/04/2021] [Accepted: 04/14/2021] [Indexed: 12/01/2022] Open
Abstract
This retrospective population-based study examined the impact of age and comorbidity burden on multimodal management and survival from colorectal cancer (CRC). From 2000 to 2015, 1479 consecutive patients, who underwent surgical resection for CRC, were reviewed for age-adjusted Charlson comorbidity index (ACCI) including 19 well-defined weighted comorbidities. The impact of ACCI on multimodal management and survival was compared between low (score 0–2), intermediate (score 3) and high ACCI (score ≥ 4) groups. Changes in treatment from 2000 to 2015 were seen next to a major increase of laparoscopic surgery, increased use of adjuvant chemotherapy and an intensified treatment of metastatic disease. Patients with a high ACCI score were, by definition, older and had higher comorbidity. Major elective and emergency resections for colon carcinoma were evenly performed between the ACCI groups, as were laparoscopic and open resections. (Chemo)radiotherapy for rectal carcinoma was less frequently used, and a higher rate of local excisions, and consequently lower rate of major elective resections, was performed in the high ACCI group. Adjuvant chemotherapy and metastasectomy were less frequently used in the ACCI high group. Overall and cancer-specific survival from stage I-III CRC remained stable over time, but survival from stage IV improved. However, the 5-year overall survival from stage I–IV colon and rectal carcinoma was worse in the high ACCI group compared to the low ACCI group. Five-year cancer-specific and disease-free survival rates did not differ significantly by the ACCI. Cox proportional hazard analysis showed that high ACCI was an independent predictor of poor overall survival (p < 0.001). Our results show that despite improvements in multimodal management over time, old age and high comorbidity burden affect the use of adjuvant chemotherapy, preoperative (chemo)radiotherapy and management of metastatic disease, and worsen overall survival from CRC.
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13
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Feng Y, Mo S, Dai W, Li Q, Cai G, Cai S. Increasing age-related survival gap among patients with colorectal cancer: a population-based retrospective study. Int J Clin Oncol 2019; 25:100-109. [PMID: 31531787 DOI: 10.1007/s10147-019-01538-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 08/29/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Survival for patients with colorectal cancer (CRC) has improved over the past decades. However, it is unclear whether older patients have benefited to the same extent as younger patients. METHODS The Surveillance, Epidemiology, and End Results (SEER) 9 registries database was queried for CRC patients from 1975 to 2009. We presented yearly data for survival with overlying loess-smoothing lines across all age groups. Another cohort was created using the SEER 18 registries database for patients diagnosed with CRC from 1973 to 2014. Yearly data for surgery-performed rate, stage proportion, and multivariate hazard ratio were performed with overlying smoothing lines across all age groups. RESULTS In the analysis SEER 9, 5-year cause-specific survival (CSS) of patients aged ≤ 54, 55-64, and 65-74 years showed robust increase since 1975; however, the survival of patients aged 75-84 years remained low despite modest improvement, and patients aged 85 or older even showed no survival gains since 1990. In the analysis of SEER 18, there has been a steady increase in the survival of patients aged ≤ 54, 55-64, 65-74, and 75-84 years as time period advanced; however, of CRC patients aged ≥ 85 years, the survival curves of period 1990-1999 and 2000-2012 could not be distinguished from each other presented with negligibly a small gap from the curve of 1980-1989. CONCLUSIONS The strong interaction between age and year of diagnosis implies that older patients have benefited less over time than younger patients, especially for patients aged ≥ 85 years.
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Affiliation(s)
- Yang Feng
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Shaobo Mo
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Weixing Dai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Qingguo Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Guoxiang Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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14
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Sarasqueta C, Perales A, Escobar A, Baré M, Redondo M, Fernández de Larrea N, Briones E, Piera JM, Zunzunegui MV, Quintana JM. Impact of age on the use of adjuvant treatments in patients undergoing surgery for colorectal cancer: patients with stage III colon or stage II/III rectal cancer. BMC Cancer 2019; 19:735. [PMID: 31345187 PMCID: PMC6659283 DOI: 10.1186/s12885-019-5910-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/08/2019] [Indexed: 12/13/2022] Open
Abstract
Background Many older patients don’t receive appropriate oncological treatment. Our aim was to analyse whether there are age differences in the use of adjuvant chemotherapy and preoperative radiotherapy in patients with colorectal cancer. Methods A prospective cohort study was conducted in 22 hospitals including 1157 patients with stage III colon or stage II/III rectal cancer who underwent surgery. Primary outcomes were the use of adjuvant chemotherapy for stage III colon cancer and preoperative radiotherapy for stage II/III rectal cancer. Generalised estimating equations were used to adjust for education, living arrangements, area deprivation, comorbidity and clinical tumour characteristics. Results In colon cancer 92% of patients aged under 65 years, 77% of those aged 65 to 80 years and 27% of those aged over 80 years received adjuvant chemotherapy (χ2trends < 0.001). In rectal cancer preoperative radiotherapy was used in 68% of patients aged under 65 years, 60% of those aged 65 to 80 years, and 42% of those aged over 80 years (χ2trends < 0.001). Adjusting by comorbidity level, tumour characteristics and socioeconomic level, the odds ratio of use of chemotherapy compared with those under age 65, was 0.3 (0.1–0.6) and 0.04 (0.02–0.09) for those aged 65 to 80 and those aged over 80, respectively; similarly, the odds ratio of use of preoperative radiotherapy was 0.9 (0.6–1.4) and 0.5 (0.3–0.8) compared with those under 65 years of age. Conclusions The probability of older patients with colorectal cancer receiving adjuvant chemotherapy and preoperative radiotherapy is lower than that of younger patients; many of them are not receiving the treatments recommended by clinical practice guidelines. Differences in comorbidity, tumour characteristics, curative resection, and socioeconomic factors do not explain this lower probability of treatment. Research is needed to identify the role of physical and cognitive functional status, doctors’ attitudes, and preferences of patients and their relatives, in the use of adjuvant therapies. Electronic supplementary material The online version of this article (10.1186/s12885-019-5910-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Sarasqueta
- Biodonostia Health Research Institute - Donostia University Hospital / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Paseo Dr. Beguiristain s/n, 20014, Donostia-San Sebastián, Gipuzkoa, Spain.
| | - A Perales
- Biodonostia Health Research Institute - Donostia University Hospital / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Paseo Dr. Beguiristain s/n, 20014, Donostia-San Sebastián, Gipuzkoa, Spain
| | - A Escobar
- Research Unit, Hospital Basurto / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Avda Montevideo, 18, 48013, Bilbao, Bizkaia, Spain
| | - M Baré
- Clinical Epidemiology and Cancer Screening, Corporació Sanitaria Parc Taulí / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - M Redondo
- Research Unit, Costa del Sol Hospital / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Autovía A-7, Km 187, 29603, Marbella, Málaga, Spain
| | - N Fernández de Larrea
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III / Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Avda de Monforte de Lemos, 5, 28029, Madrid, Spain
| | - E Briones
- Epidemiology Unit, Seville Health District, Andalusian Health Service / Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Avda de la Constitución, 18, 41071, Seville, Spain
| | - J M Piera
- Medical Oncology Unit, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014, Donostia-San Sebastián, Gipuzkoa, Spain
| | - M V Zunzunegui
- Departement de médecine sociale et préventive Institut de recherche en santé publique (IRSPUM), University of Montréal, Pavillon 7101, salle 3111 7101, Avenue du Parc Montréal, Montréal, Québec, H3N 1X9, Canada
| | - J M Quintana
- Research Unit, Galdakao-Usansolo Hospital / REDISSEC, Labeaga Auzoa, 48960, Galdakao, Bizkaia, Spain
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15
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Tapia Rico G, Karapetis C, Townsend AR, Piantadosi C, Padbury R, Roy A, Maddern G, Moore J, Carruthers S, Roder D, Price TJ. Do we know what to do with our nonagenarian and centenarian patients with metastatic colorectal cancer (mCRC)? Results from the South Australian mCRC registry. Acta Oncol 2018; 57:1455-1457. [PMID: 29775123 DOI: 10.1080/0284186x.2018.1473640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Gonzalo Tapia Rico
- Department of Medical Oncology, The Queen Elizabeth Hospital and University of Adelaide, Adelaide, Australia
| | - Christos Karapetis
- Department of Medical Oncology, Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - Amanda R. Townsend
- Department of Medical Oncology, The Queen Elizabeth Hospital and University of Adelaide, Adelaide, Australia
| | | | - Rob Padbury
- Department of Surgery, Flinders Medical Centre, Bedford Park, Australia
| | - Amitesh Roy
- Department of Medical Oncology, Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - Guy Maddern
- Department of Surgery, The Queen Elizabeth Hospital, Adelaide, Australia
- Surgery, University of South Australia, Adelaide, Australia
| | - James Moore
- Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - David Roder
- Epidemiology, University of South Australia, Adelaide, Australia
| | - Timothy J. Price
- Department of Medical Oncology, The Queen Elizabeth Hospital and University of Adelaide, Adelaide, Australia
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16
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Schreckenbach T, Zeller MV, El Youzouri H, Bechstein WO, Woeste G. Identification of factors predictive of postoperative morbidity and short-term mortality in older patients after colorectal carcinoma resection: A single-center retrospective study. J Geriatr Oncol 2018; 9:649-658. [PMID: 29779798 DOI: 10.1016/j.jgo.2018.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/23/2018] [Accepted: 05/01/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The aim of this study is to investigate the effect of age on patient outcome after colorectal carcinoma (CRC) resection in patients over 65 years of age. METHODS This study included patients aged 65 years and older who underwent CRC resection between 2003 and 2013 at a single-center institution. Patients were divided into two groups: Group A (65-74 years old) and Group B (≥75 years old). RESULTS Multivariable logistic analysis of 415 patients revealed serum albumin levels on the third postoperative day (POD) (Odds Ratio (OR), 0.44; 95% CI, 0.21-0.94; P = 0.03) and C-reactive protein (CRP) levels (OR, 1.05; 95% CI, 1.00-1.01; P = 0.04) in patients with colon cancer as predictive factors for morbidity. In addition, the multivariable logistic analysis revealed serum albumin levels (OR, 0.27; 95% CI, 0.08-0.87; P = 0.03) in patients with rectal cancer as predictive factors for morbidity. The multivariate Cox Proportional Hazards Model identified re-intervention for colon cancer (Hazard Ratio (HR), 4.57; 95% CI, 1.36-15.4 P = 0.01) and for rectal cancer (HR, 11.8; 95% CI, 1.08-129 P = 0.04) as a predictive factor for 30-day mortality. Serum albumin level on the third POD was predictive of 30-day mortality (HR, 0.30; 95% CI, 0.13-0.71; P = 0.01) and of 1-year mortality (HR, 0.34; 95% CI, 0.17-0.66; P < 0.01) in patients with colon cancer. CONCLUSION Age is not predictive of postoperative morbidity and mortality in patients with CRC. Serum albumin levels on the third POD can predict morbidity and mortality for colon and rectal carcinoma in older patients undergoing colorectal resections.
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Affiliation(s)
- Teresa Schreckenbach
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany.
| | - Matthias Valentin Zeller
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Hanan El Youzouri
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Wolf Otto Bechstein
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Guido Woeste
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
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17
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Trends in net survival from cervical cancer in six European Latin countries: results from the SUDCAN population-based study. Eur J Cancer Prev 2018; 26 Trends in cancer net survival in six European Latin Countries: the SUDCAN study:S92-S99. [PMID: 28005611 DOI: 10.1097/cej.0000000000000292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cancer survival is a key measure of the effectiveness of a healthcare system. As differences in healthcare systems are present among European Latin countries, it is of interest to look specifically at their similarities and differences in terms of cancer survival. Incident cases were extracted from the EUROCARE-V database for France, Italy, Spain, Switzerland, Portugal, and Belgium. One and 5-year net survivals (NS) were calculated for the period 2000-2004 using the Pohar-Perme estimator. Trends in NS over the 1992-2004 period and changes in the pattern of cancer excess mortality rate until 5 years after diagnosis were examined using a multivariate excess mortality rate model. There were moderate differences in age-standardized NS between countries (5-year NS range: 83-88%), but significant differences in the age groups 15-54 and 55-74 years (at 5 years up to +16 and +18% between any two countries). During the study period, excess mortality and NS improved in Italy, Spain, and Portugal. In Italy and Portugal, this improvement was slightly similar at ages 40, 55, and 70 whereas, in Spain, there was a sharp increase in NS at age 55. Because of this improvement, excess mortality and NS were similar in all six countries in 2004. Excess mortality peaked around 1 year after diagnosis in the youngest ages, but decreased gradually in the elderly. Detailed analyses showed differences in excess mortality and NS from cervical cancer between European Latin countries. However, these differences decreased over the study period because of the considerable improvement in Spain, Italy, and Portugal.
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18
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Gagnière J, Veziant J, Pereira B, Pezet D, Le Roy B, Slim K. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for the Elderly: Is It Reasonable? A Meta-Analysis. Ann Surg Oncol 2017; 25:709-719. [PMID: 29282602 DOI: 10.1245/s10434-017-6313-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Whether cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is safe and worthwhile for elderly patients remains unclear. This meta-analysis of outcomes after CRS plus HIPEC for the elderly aimed to generate a higher level of evidence and precise indications for these patients. METHODS A systematic literature search for studies reporting postoperative outcomes after CRS plus HIPEC for elderly patients was performed in the MEDLINE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Web of Knowledge Conference Proceedings Citation Index-Science, and Google Scholar databases. The included studies evaluated the overall 30-day postoperative morbidity, 90-day postoperative mortality, grade 3 or higher postoperative morbidity, rates of anastomotic leaks, reoperation and readmission, and length of hospital stay. RESULTS The inclusion criteria were met by 13 retrospective studies involving 2544 patients. Considering only comparative studies, the 90-day postoperative mortality was significantly increased for elderly patients [odds ratio (OR), 0.49; 95% confidence interval (CI), 0.27-0.88; I 2 = 79%]. The 30-day grade 3 or higher postoperative morbidity was increased in the patients 70 years of age or older (14.5%; 95% CI 8.1-24.4 vs. 32.3%; 95% CI 22.4-44.0%; p = 0.004; I 2 = 85%). The overall 30-day postoperative morbidity, rates of anastomotic leaks, reoperation and readmission, and length of hospital stay were not affected by age. CONCLUSIONS Treatment of the elderly with CRS plus HIPEC was associated with increased severe postoperative morbidity and mortality. However, these conclusions should be weighted given the existence of major biases in the included studies. Age alone probably would not be a formal contraindication, but frailty should be taken into account. Further prospective studies are needed.
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Affiliation(s)
- Johan Gagnière
- Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France. .,U1071 INSERM, Université Clermont-Auvergne, Clermont-Ferrand, France.
| | - Julie Veziant
- Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.,U1071 INSERM, Université Clermont-Auvergne, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics, Délégation à la Recherche Clinique et à l'Innovation, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Denis Pezet
- Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.,U1071 INSERM, Université Clermont-Auvergne, Clermont-Ferrand, France
| | - Bertrand Le Roy
- Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Karem Slim
- Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
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Fowler H, Belot A, Njagi EN, Luque-Fernandez MA, Maringe C, Quaresma M, Kajiwara M, Rachet B. Persistent inequalities in 90-day colon cancer mortality: an English cohort study. Br J Cancer 2017; 117:1396-1404. [PMID: 28859056 PMCID: PMC5672924 DOI: 10.1038/bjc.2017.295] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/31/2017] [Accepted: 08/03/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Variation in colon cancer mortality occurring shortly after diagnosis is widely reported between socio-economic status (SES) groups: we investigated the role of different prognostic factors in explaining variation in 90-day mortality. METHODS National cancer registry data were linked with national clinical audit data and Hospital Episode Statistics records for 69 769 adults diagnosed with colon cancer in England between January 2010 and March 2013. By gender, logistic regression was used to estimate the effects of SES, age and stage at diagnosis, comorbidity and surgical treatment on probability of death within 90 days from diagnosis. Multiple imputations accounted for missing stage. We predicted conditional probabilities by prognostic factor patterns and estimated the effect of SES (deprivation) from the difference between deprivation-specific average predicted probabilities. RESULTS Ninety-day probability of death rose with increasing deprivation, even after accounting for the main prognostic factors. When setting the deprivation level to the least deprived group for all patients and keeping all other prognostic factors as observed, the differences between deprivation-specific averaged predicted probabilities of death were greatly reduced but persisted. Additional analysis suggested stage and treatment as potential contributors towards some of these inequalities. CONCLUSIONS Further examination of delayed diagnosis, access to treatment and post-operative care by deprivation group may provide additional insights into understanding deprivation disparities in mortality.
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Affiliation(s)
- H Fowler
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - A Belot
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - E N Njagi
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - M A Luque-Fernandez
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - C Maringe
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - M Quaresma
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - M Kajiwara
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - B Rachet
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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20
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Guimas V, Boustani J, Schipman B, Lescut N, Puyraveau M, Bosset JF, Servagi-Vernat S. Preoperative Chemoradiotherapy for Rectal Cancer in Patients Aged 75 Years and Older: Acute Toxicity, Compliance with Treatment, and Early Results. Drugs Aging 2017; 33:419-25. [PMID: 27138958 DOI: 10.1007/s40266-016-0367-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Treatment of locally advanced rectal cancer (T3-T4 or N+) is based on short-course radiotherapy (RT) or chemoradiotherapy (CRT) followed by surgery. It is estimated that 30-40 % of rectal cancer occurs in patients aged 75 years or more. Data on adherence to neoadjuvant CRT and its safety remain poor owing to the under-representation of older patients in randomized clinical trials and the discordance in the results from retrospective studies. The aim of this study was to assess adherence with preoperative CRT and tolerability in older patients with a stage II/III unresectable rectal cancer. METHODS Patients aged 75 years or more with stage II/III rectal cancer treated with preoperative CRT at the University Hospital of Besancon from 1993 to 2011 were included. Feasibility, toxicities, overall survival, and local recurrence rates were studied. RESULTS Fifty-six patients with a Charlson score from 2 to 6 were included. The mean age was 78 years. The compliance rates for RT and chemotherapy were 91 and 41.1 %, respectively. Two patients stopped CRT; one for hemostatic surgery, and one for severe sepsis. For CRT, the rate of grade ≥3 toxicity was 14.29 %, mainly the digestive type. Fifty-two patients underwent tumor resection, including 76.79 % total mesorectal excision resection with 84.6 % complete resection, and a rate of postoperative complications of 39.6 %. At 2 years, the overall survival and local recurrences rates were 87.3 and 7.8 %, respectively. CONCLUSION In older patients, selected preoperative CRT, with an adapted chemotherapy dose, is well tolerated. The main toxicity was gastrointestinal. Adherence to RT is comparable to that of younger patients.
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Affiliation(s)
- Valentine Guimas
- Department of Radiation Oncology, Besançon University Hospital, University Hospital of Franche-Comté, Boulevard Fleming, 25030, Besançon Cedex, France
| | - Jihane Boustani
- Department of Radiation Oncology, Besançon University Hospital, University Hospital of Franche-Comté, Boulevard Fleming, 25030, Besançon Cedex, France
| | | | - Nicolas Lescut
- Department of Radiation Oncology, Besançon University Hospital, University Hospital of Franche-Comté, Boulevard Fleming, 25030, Besançon Cedex, France
| | - Marc Puyraveau
- Department of Clinical Investigation Center, Besançon University Hospital, Besançon, France
| | - Jean François Bosset
- Department of Radiation Oncology, Besançon University Hospital, University Hospital of Franche-Comté, Boulevard Fleming, 25030, Besançon Cedex, France
| | - Stéphanie Servagi-Vernat
- Department of Radiation Oncology, Besançon University Hospital, University Hospital of Franche-Comté, Boulevard Fleming, 25030, Besançon Cedex, France.
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21
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Mäkelä JT, Klintrup KH, Rautio TT. Mortality and Survival after Surgical Treatment of Colorectal Cancer in Patients Aged over 80 Years. Gastrointest Tumors 2017; 4:36-44. [PMID: 29071263 DOI: 10.1159/000477721] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/08/2017] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The purpose of this study was to identify the clinical factors and tumor characteristics that predict the outcome of colorectal cancer patients aged >80 years. MATERIALS AND METHODS The data of 186 patients aged >80 years with colorectal cancer were collected from a computer database, and the variables were analyzed by both uni- and multivariate analyses. RESULTS The 30-day mortality was 4% and the 90-day mortality 10%. The 1-year survival was 76%, and 27 (61%) of the 44 deaths were unrelated to cancer. The overall 5-year survival was 36%, the median survival 38 months, and the cancer-specific survival 40%. The recurrence rate after radical surgery was 22% and it was not affected by age. Kaplan-Meier estimates indicated that age, number of underlying diseases, radical operation, Union for International Cancer Control stage of the tumor, tumor size, number of lymph nodes involved, venous invasion, and recurrent disease were significant predictors of survival, but in the Cox regression model, only radical operation and venous invasion were independent prognostic factors for survival. CONCLUSIONS After good surgical selection, low early mortality and acceptable long-term survival can be achieved even in the oldest old patients with colorectal cancer. However, low early mortality seems to underestimate the effects of surgery during the first postoperative year.
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Affiliation(s)
- Jyrki Tapani Mäkelä
- Department of Surgery, Surgical Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Kai Hans Klintrup
- Department of Surgery, Surgical Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Tero Tapani Rautio
- Department of Surgery, Surgical Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
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Influence of previous abdominal surgery on surgical outcomes between laparoscopic and open surgery in elderly patients with colorectal cancer: subanalysis of a large multicenter study in Japan. J Gastroenterol 2017; 52:695-704. [PMID: 27650199 DOI: 10.1007/s00535-016-1262-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/05/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of the present study was to examine the technical and oncological feasibility of laparoscopic surgery (LAP) in elderly patients with a history of abdominal surgery. METHODS We conducted a propensity score-matched case-control study of colorectal cancer (CRC) patients aged ≥80 years that were treated at 41 hospitals between 2003 and 2007. We included 601 patients who had a history of abdominal surgery and underwent curative and elective surgery for stage 0 to III CRC. After the matching procedure, 153 patients were included in each cohort. The surgical outcomes of LAP and open surgery (OS) were compared. P-values of <0.05 were considered statistically significant. RESULTS LAP resulted in a significantly longer surgical time (220 vs. 170 min, p < 0.001), but significantly less intraoperative blood loss (39 vs. 100 ml, p < 0.001). A number of postoperative recovery-related parameters, including the length of the hospitalization period (12 vs. 14 days, p = 0.002), and the days to the resumption of fluid (2 vs. 3 days, p < 0.001) and solid food intake (4 vs. 5 days, p < 0.001), were significantly better in the LAP group. Moreover, the overall morbidity rate (43 vs. 66 %, p = 0.009) and the frequency of postoperative ileus (7 vs. 19 %, p = 0.023) were significantly lower in the LAP group, while the frequencies of other morbidities did not differ significantly between the groups. In the survival analyses, overall survival and disease-free survival did not differ between the two groups. CONCLUSIONS In this population, LAP can be performed safely in elderly CRC patients with a history of abdominal surgery, and LAP resulted in a lower postoperative morbidity rate than OS.
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23
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Joachim C, Godaert L, Dramé M, Véronique-Baudin J, Macni J, Smith-Ravin J, Novella JL, Mahmoudi R. Overall survival in elderly patients with colorectal cancer: A population-based study in the Caribbean. Cancer Epidemiol 2017; 48:85-91. [PMID: 28426981 DOI: 10.1016/j.canep.2017.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/15/2017] [Accepted: 03/18/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Population-based Cancer registries (PBCR) play an important role in cancer surveillance and research. The aim of this study was to examine overall survival in elderly patients with colorectal cancer (CRC) by analysing data from the Martinique PBCR between 1993 and 2012. METHODS The log-rank test was used to assess the statistical differences of the survival curves by each categorical variable: age at diagnosis, sex, histology, zone of residence, subsite, stage at diagnosis, and chemotherapy. A multivariable Cox model was performed to identify independent prognostic factors for overall survival in elderly patients with colorectal cancer. RESULTS Among 2230 patients included in the study, 60.8% were aged≥65years; mean age at diagnosis of these patients was 75.7±7.2years. For the period 2008-2012, 532 elderly patients were analysed; mean age of those receiving chemotherapy was 73.0±0.4 versus 77.9±0.4years for those not receiving chemotherapy (p<0.0001). Stage at diagnosis was evaluated in 87.8% (467/532) of patients; 63.0% (294/467) had stage III-IV and 49.3% of these patients (145/294) received chemotherapy. Chemotherapy was less frequently prescribed in patients aged 75-84 and ≥85 years as compared to those aged 65-74 years (41.1% and 15.0% versus 64.6% respectively; p<0.0001). Stage III-IV at diagnosis (HR=5.25; 3.70-7.45; p<0.0001), and not receiving chemotherapy (HR=3.05; 2.23-4.16; p<0.0001), were independent prognostic factors for overall survival. CONCLUSION Our study highlights the role of PBCR in evaluating cancer survival and patterns of care in elderly people of the French West- Indies. Chemotherapy was less frequently prescribed among the elderly.
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Affiliation(s)
- Clarisse Joachim
- Registre Général des cancers de la Martinique, UF 1441 Registre des cancers, Pôle de Cancérologie Hématologie Urologie Pathologie, CHU de Martinique, 97200 Fort-de-France, Martinique, France.
| | - Lidvine Godaert
- Pôle de Gériatrie, CHU de Martinique, 97200 Fort-de-France, Martinique, France
| | - Moustapha Dramé
- Faculté de Médecine, EA 3797, Université de Reims Champagne-Ardenne, 51095 Reims, France; Unité d'aide Méthodologique, Pôle Recherche et Santé publique, CHU de Reims, 51000 Reims, France
| | - Jacqueline Véronique-Baudin
- Registre Général des cancers de la Martinique, UF 1441 Registre des cancers, Pôle de Cancérologie Hématologie Urologie Pathologie, CHU de Martinique, 97200 Fort-de-France, Martinique, France
| | - Jonathan Macni
- Registre Général des cancers de la Martinique, UF 1441 Registre des cancers, Pôle de Cancérologie Hématologie Urologie Pathologie, CHU de Martinique, 97200 Fort-de-France, Martinique, France
| | - Juliette Smith-Ravin
- Université des Antilles, EA929 groupe BIOSPHERES, Campus de Schœlcher, 97200 Fort-de-France, Martinique, France
| | - Jean-Luc Novella
- Faculté de Médecine, EA 3797, Université de Reims Champagne-Ardenne, 51095 Reims, France; Département de Médecine Interne et Gériatrie, CHU de Reims, 51000 Reims, France
| | - Rachid Mahmoudi
- Faculté de Médecine, EA 3797, Université de Reims Champagne-Ardenne, 51095 Reims, France; Département de Médecine Interne et Gériatrie, CHU de Reims, 51000 Reims, France
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24
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Guan X, Hu H, Chen W, Jiang Z, Liu Z, Zhao Z, Chen Y, Wang G, Wang X. Comparison of long-term outcome between hemicolectomy and partial colectomy in the elderly: a large population-based study. Oncotarget 2017; 8:51076-51085. [PMID: 28881631 PMCID: PMC5584232 DOI: 10.18632/oncotarget.16993] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 02/21/2017] [Indexed: 01/04/2023] Open
Abstract
Due to large progress has been achieved in surgical techniques, anesthesia and perioperative care, it is accepted that the very elderly colon cancer (CC) patient is not contraindication for surgery. However, it is a controversy that an extended or a less aggressive surgical approach should be performed for this population. Here, we identified 28110 CC patients aged ≥80 from Surveillance, Epidemiology, and End-Results (SEER) database. The surgical approaches included extended hemicolectomy (HC) and partial colectomy (PC). 5-year cancer specific survival (CSS) was obtained. Kaplan-Meier methods and Cox regression models were used to assess the correlations between prognostic factors and long-term survival. The 5-year CSS for patients treated with HC were 45.6%, which were similar to patients who received PC (44.8%), the survival difference has no statistical significance (P=0.087). The result following propensity score matching further confirmed long-term survival were equal between HC and PC. However, patients in AJCC T3/T4 stage and with tumor size ≥5cm could obtain survival benefit from the extended surgery. In conclusion, most of elderly CC patients could not obtain survival benefit from extended resection. Partial colectomy should also be considered as an alternative approach for this group of patients.
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Affiliation(s)
- Xu Guan
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Department of Colorectal Surgery, Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hanqing Hu
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wei Chen
- Follow Up Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zheng Jiang
- Department of Colorectal Surgery, Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zheng Liu
- Department of Colorectal Surgery, Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhixun Zhao
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yinggang Chen
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guiyu Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xishan Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Department of Colorectal Surgery, Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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25
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Rasouli MA, Moradi G, Roshani D, Nikkhoo B, Ghaderi E, Ghaytasi B. Prognostic factors and survival of colorectal cancer in Kurdistan province, Iran: A population-based study (2009-2014). Medicine (Baltimore) 2017; 96:e5941. [PMID: 28178134 PMCID: PMC5312991 DOI: 10.1097/md.0000000000005941] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/19/2016] [Accepted: 12/27/2016] [Indexed: 01/05/2023] Open
Abstract
Colorectal cancer (CRC) survival varies at individual and geographically level. This population-based study aimed to evaluating various factors affecting the survival rate of CRC patients in Kurdistan province.In a retrospective cohort study, patients diagnosed as CRC were collected through a population-based study from March 1, 2009 to 2014. The data were collected from Kurdistan's Cancer Registry database. Additional information and missing data were collected reference to patients' homes, medical records, and pathology reports. The CRC survival was calculated from the date of diagnosis to the date of cancer-specific death or the end of follow-up (cutoff date: October 2015). Kaplan-Meier method and log-rank test were used for the univariate analysis of survival in various subgroups. The proportional-hazard model Cox was also used in order to consider the effects of different factors on survival including age at diagnosis, place of residence, marital status, occupation, level of education, smoking, economic status, comorbidity, tumor stage, and tumor grade.A total number of 335 patients affected by CRC were assessed and the results showed that 1- and 5-year survival rate were 87% and 33%, respectively. According to the results of Cox's multivariate analysis, the following factors were significantly related to CRC survival: age at diagnosis (≥65 years old) (HR 2.08, 95% CI: 1.17-3.71), single patients (HR 1.62, 95% CI: 1.10-2.40), job (worker) (HR 2.09, 95% CI: 1.22-3.58), educational level: diploma or below (HR 0.61, 95% CI: 0.39-0.92), wealthy economic status (HR 0.51, 95% CI: 0.31-0.82), tumor grade in poorly differentiated (HR 2.25, 95% CI: 1.37-3.69), and undifferentiated/anaplastic grade (HR 2.90, 95% CI: 1.67-4.98).We found that factors such as low education, inappropriate socioeconomic status, and high tumor grade at the time of disease diagnosis were effective in the poor survival of CRC patients in Kurdistan province; this, which need more attention.
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Affiliation(s)
- Mohammad Aziz Rasouli
- Student Research Committee
- Department of Epidemiology and Biostatistics, Faculty of Medicine
| | - Ghobad Moradi
- Social Determinants of Health Research Center
- Department of Epidemiology and Biostatistics, Faculty of Medicine
| | - Daem Roshani
- Social Determinants of Health Research Center
- Department of Epidemiology and Biostatistics, Faculty of Medicine
| | - Bahram Nikkhoo
- Department of Pathology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ebrahim Ghaderi
- Social Determinants of Health Research Center
- Department of Epidemiology and Biostatistics, Faculty of Medicine
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Shen Y, Zhang S, Zhou J, Chen J. Cohort Research in "Omics" and Preventive Medicine. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1005:193-220. [PMID: 28916934 DOI: 10.1007/978-981-10-5717-5_9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cohort studies are observational studies in which the investigator determines the exposure status of subjects and then follows them for subsequent outcomes. The incidence of outcomes is observed in the exposed group and compared with that in a nonexposed group. Recently, new epidemiologic strategies have encouraged cohort research information exchange and cooperation to improve the cognition of disease etiology, such as case-cohort design and nested case-control study, which is available for "omics" data. Meanwhile, large-scale cohort studies using a prospective multiple design and long follow-ups have explored some of the challenges in preventive medicine. Cohort study can bridge the gap between the micro and macro research.This chapter is divided into three parts: 1. Basic knowledge of cohort study, which included the definition of cohort study and different types of cohort study, how to design the cohort study, data analysis for the cohort study, sources of bias in cohort studies, tools and software for cohort studies, and strengths and limitations of cohort study 2. Cohort study for "omics" data analysis, which introduced three related methodologically distinct study designs, case-cohort design for genomic cohort study, nested case-control design for transcriptomics cohort data, and population-based design for integrative "omics" cohort 3. Perspectives on cohort study including data-driven medicine and cohort research, cohort research for healthcare medicine, and cohort research for preventive medicine.
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Affiliation(s)
- Yi Shen
- Department of Epidemiology and Medical Statistics, Nantong University, Nantong, China
| | - Sheng Zhang
- Department of Epidemiology and Medical Statistics, Nantong University, Nantong, China
| | - Jie Zhou
- Department of Epidemiology and Medical Statistics, Nantong University, Nantong, China
| | - Jiajia Chen
- School of Chemistry, Biology and Materials Engineering, Suzhou University of Science and Technology, No.1 Kerui road, Suzhou, Jiangsu, 215011, China.
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Simkens GA, Verwaal VJ, Lemmens VE, Rutten HJ, de Hingh IH. Short-term outcome in patients treated with cytoreduction and HIPEC compared to conventional colon cancer surgery. Medicine (Baltimore) 2016; 95:e5111. [PMID: 27741129 PMCID: PMC5072956 DOI: 10.1097/md.0000000000005111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is an extensive procedure with considerable morbidity. Since only few hospitals perform CRS + HIPEC, this might lead to confounded outcomes between hospitals when audited. This study aims to compare outcomes between peritoneally metastasized (PM) colon cancer patients treated with CRS + HIPEC and patients undergoing conventional colon surgery. Furthermore, the impact of CRS + HIPEC on the risk of postoperative complications will be assessed, probably leading to better insight into how to report on postoperative outcomes in this distinct group of patients undergoing extensive colon surgery.All patients with primary colon cancer who underwent segmental colon resection in a tertiary referral hospital between 2011 and 2014 were included in this prospective cohort study. Outcome after surgery was compared between patients who underwent additional CRS + HIPEC treatment or conventional surgery.Consequently, 371 patients underwent surgery, of which 43 (12%) underwent CRS + HIPEC. These patients were younger and healthier than patients undergoing conventional surgery. Tumor characteristics were less favorable and surgery was more extensive in CRS + HIPEC patients. The morbidity rate was also higher in CRS + HIPEC patients (70% vs 41%; P < 0.001). CRS + HIPEC was an independent predictor of postoperative complications (odds ratio 6.4), but was not associated with more severe postoperative complications or higher treatment-related mortality.Although patients with colonic PM undergoing CRS + HIPEC treatment were younger and healthier, the postoperative outcome was worse. This is most probably due to less favorable tumor characteristics and more extensive surgery. Nevertheless, CRS + HIPEC treatment was not associated with severe complications or increased treatment-related mortality. These results stress the need for adequate case-mix correction in colorectal surgery audits.
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Affiliation(s)
- Geert A. Simkens
- Department of Surgical Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Vic J. Verwaal
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Valery E. Lemmens
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Harm J. Rutten
- Department of Surgical Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Ignace H. de Hingh
- Department of Surgical Oncology, Catharina Hospital, Eindhoven, The Netherlands
- Correspondence: Ignace H. de Hingh, Catharina Hospital Eindhoven, Department of Surgical Oncology, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands (e-mail: )
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28
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Alyami M, Lundberg P, Kepenekian V, Goéré D, Bereder JM, Msika S, Lorimier G, Quenet F, Ferron G, Thibaudeau E, Abboud K, Lo Dico R, Delroeux D, Brigand C, Arvieux C, Marchal F, Tuech JJ, Guilloit JM, Guyon F, Peyrat P, Pezet D, Ortega-Deballon P, Zinzindohoue F, de Chaisemartin C, Kianmanesh R, Glehen O, Passot G. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis in the Elderly: A Case-Controlled, Multicenter Study. Ann Surg Oncol 2016; 23:737-745. [PMID: 27600619 DOI: 10.1245/s10434-016-5519-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study was designed to identify factors associated with morbidity and mortality in patients older than 70 years who underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis (PC). BACKGROUND Major surgery is associated with higher morbidity and mortality in elderly patients. For PC, CRS and HIPEC is the only current potential curative therapy, but the risks inherent to this patient population have called its benefits into question. METHODS We retrospectively analyzed a multi-center database from 1989 to 2015. All patients who underwent CRS and HIPEC for PC were selected and patients older than 70 years were matched 1:4 with a younger cohort according to cancer origin, peritoneal cancer index (PCI), and completeness of cytoreduction. Major morbidity and mortality were analyzed. RESULTS Of 2328 patients, 188 patients older than aged 70 years were matched with 704 younger patients. Patients older than aged 70 years demonstrated a higher American Society of Anesthesiologist score (≥ASA III 10.8 vs. 6.6 %, p = 0.008). There was no difference in overall 90-day morbidity (≥70: 45.7 % vs. <70: 44.5 %; p = 0.171); however, patients older than 70 years had significantly more cardiovascular complications (13.8 vs. 9.2 %, p = 0.044). Differences between the older and younger cohorts failed to reach significance for 90-day mortality (5.4 and 2.7 %, respectively; p = 0.052), and failure-to-rescue (11.6 and 6.1 %, respectively; p = 0.078). In multivariate analysis, PCI > 7 (95 % CI 1.051-5.798, p = 0.038) and HIPEC duration (95 % CI 1.106-6.235, p = 0.028) were independent factors associated with morbidity in elderly patients. CONCLUSIONS CRS and HIPEC appear feasible for selected patients older than aged 70 years, albeit with a higher risk of medical complications associated with increased mortality.
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Affiliation(s)
- Mohammad Alyami
- Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France.,King Abdullah Scholarship Program, Saudi Arabian Cultural Bureau, Paris, France
| | - Peter Lundberg
- Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France
| | - Vahan Kepenekian
- Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France
| | - Diane Goéré
- Department of Surgical Oncology, Gustave Roussy Institute, Villejuif, France
| | - Jean-Marc Bereder
- Department of Digestive Surgery, Archet 2 University Hospital, Nice, France
| | - Simon Msika
- Department of Surgery, Louis Mourier University Hospital, Colombes, France
| | - Gérard Lorimier
- Department of Digestive Surgery, Angers University Hospital, Angers, France
| | - François Quenet
- Department of Surgical Oncology, Val d'Aurelle Montpellier Cancer Center, Montpellier, France
| | - Gwenaël Ferron
- Department of Surgical Oncology, Claudius Regaud Institute IUTC, Toulouse, France
| | - Emilie Thibaudeau
- Department of Surgical Oncology, ICO René Gauducheau Cancer Center, Saint-Herblain, France
| | - Karine Abboud
- Department of Digestive Surgery, St Etienne University Hospital, Saint-Étienne, France
| | - Réa Lo Dico
- Surgical Oncologic & Digestive Unit, Lariboisière University Hospital, Paris, France
| | - Delphine Delroeux
- Department of Digestive Surgery, Minjoz University Hospital, Besançon, France
| | - Cécile Brigand
- Department of Digestive Surgery, Hautepierre University Hospital, Strasbourg, France
| | - Catherine Arvieux
- Department of Digestive Surgery, Grenoble University Hospital, Grenoble, France
| | - Frédéric Marchal
- Department of Surgical Oncology, Institut de Cancérologie de Lorraine, CRAN CNRS UMR 7039, Université de Lorraine, Vandœuvre-Lès-Nancy, France
| | - Jean-Jacques Tuech
- Department of Digestive Surgery, Charles Nicolle University Hospital, Rouen, France
| | - Jean-Marc Guilloit
- Department of Surgical Oncology, Francois Baclesse Comprehensive Cancer Center, Caen, France
| | - Frédéric Guyon
- Department of Surgical Oncology, Bergonie Institute, Bordeaux, France
| | - Patrice Peyrat
- Department of Surgery, Léon Bérard Comprehensive Cancer Center, Lyon, France
| | - Denis Pezet
- Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France
| | - Pablo Ortega-Deballon
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - Franck Zinzindohoue
- Department of Digestive and General Surgery, G. Pompidou European Hospital, Paris, France
| | | | - Reza Kianmanesh
- Department of Digestive Surgery, Robert Debré University Hospital, Reims, France
| | - Olivier Glehen
- Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France.,EMR 37-38, Lyon 1 University, Lyon, France
| | - Guillaume Passot
- Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France. .,EMR 37-38, Lyon 1 University, Lyon, France. .,Département Chirurgie Générale, Digestive et Endocrinienne, CHU Lyon Sud, Pierre-Bénite, France.
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Adachi T, Hinoi T, Kinugawa Y, Enomoto T, Maruyama S, Hirose H, Naito M, Tanaka K, Miyake Y, Watanabe M. Lower body mass index predicts worse cancer-specific prognosis in octogenarians with colorectal cancer. J Gastroenterol 2016; 51:779-87. [PMID: 26660524 DOI: 10.1007/s00535-015-1147-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/09/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND High body mass index (BMI) is a risk factor for colorectal cancer. However, the prognostic impact of BMI and other factors may differ between elderly and younger colorectal cancer patients. We analyze here prognostic factors in the surgical management of octogenarians with colorectal cancer and clarify the prognostic impact of BMI. METHODS Cox regression analysis and propensity score methods were used to retrospectively examine the association of BMI with mortality in 1613 octogenarian patients who underwent curative surgery for stage 0-III colorectal cancer. RESULTS In the Cox regression analysis, lower BMI (<18.5 kg/m(2); p = 0.001), age ≥83 years (p = 0.008), American Society of Anesthesiology class ≥3: (p = 0.001), performance status ≥2 (p = 0.003), Union for International Cancer Control (UICC) stage ≥III (p = 0.001), and postoperative adverse events (p = 0.001) were independently associated with decreased overall survival. Lower BMI (p = 0.001) and UICC stage ≥III (p = 0.001) were independently associated with decreased cancer-specific survival. After covariate adjustment, lower BMI was a risk factor for overall [hazard ratio (HR) 1.62; 95 % confidence interval (CI) 1.26-2.05; p = 0.0004] and cancer-specific survival (HR 2.00; 95 % CI 1.39-2.87; p = 0.0038) compared with normal BMI (18.5-24.9 kg/m(2)). CONCLUSIONS Lower BMI is significantly and independently associated with increased mortality risk in octogenarians who undergo curative surgery for colorectal cancer. Lower BMI should be used for prognosis assessment in octogenarians with colorectal cancer.
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Affiliation(s)
- Tomohiro Adachi
- Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Takao Hinoi
- Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yusuke Kinugawa
- Department of Colon and Rectal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Toshiyuki Enomoto
- Department of Surgery, Toho University, Ohashi Medical Center, Tokyo, Japan
| | - Satoshi Maruyama
- Department of Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Hajime Hirose
- Department of Surgery, Kinan Hospital, Wakayama, Japan
| | - Masanori Naito
- Department of Surgery, Kitasato University, School of Medicine, Sagamihara, Kanagawa, Japan
| | - Keitaro Tanaka
- Department of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan
| | - Yasuhiro Miyake
- Department of Surgery, Nishinomiya Municipal Central Hospital, Nishinomiya, Hyougo, Japan
| | - Masahiko Watanabe
- Department of Surgery, Kitasato University, School of Medicine, Japan Society of Laparoscopic Colorectal Surgery, Sagamihara, Kanagawa, Japan
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Ukegjini K, Zadnikar M, Warschkow R, Müller S, Schmied BM, Marti L. Baseline mortality-adjusted survival in colon cancer patients. Langenbecks Arch Surg 2016; 401:633-41. [PMID: 27102323 DOI: 10.1007/s00423-016-1432-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 04/11/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND This investigation assessed the baseline mortality-adjusted survival after colon cancer resection. MATERIAL AND METHODS In total, 523 patients with adenocarcinoma of the colon who underwent primary colon resection at Kantonsspital St. Gallen, Switzerland, between 1996 and 2008 were included. RESULTS The median follow-up was 25 months for all patients and 39 months for those who survived until the end of the follow-up. The 5-year relative survival rate was 63.2 % (95 % CI 57.3-69.6 %), and the overall survival rate was 52 % (95 % CI 47.6-57.7 %). After curative resection of stage I-III colon cancer, 40 % of the observed deaths were cancer-related and 60 % reflected the baseline mortality. In stage I, the 5-year relative survival was 103.2 % (95 % CI 91.4-116.5 %) and was not different from a matched population (p = 0.820). In multivariate analysis, good general health and less advanced cancer stages were associated with better relative and overall survival rates. A more advanced age was associated with better relative survival, but worse overall survival. CONCLUSIONS The analysis of relative survival of patients exclusively with colon cancer revealed that prognosis of patients suffering from stage I colon cancer does not differ significantly from that of the general population. In more advanced stages, a relevant fraction of deaths is not cancer-related. As the stage determines a patient's survival, early diagnosis is crucial for prognosis.
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Affiliation(s)
- Kristjan Ukegjini
- Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
| | - Marcel Zadnikar
- Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
| | - Rene Warschkow
- Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
- Institute of Medical Biometry and Informatics, University of Heidelberg, 69120, Heidelberg, Germany
| | - Sascha Müller
- Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
| | - Bruno M Schmied
- Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
| | - Lukas Marti
- Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167, Mannheim, Germany.
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Knight K, Oliphant R, Maxwell F, McKenzie C, McCann M, Hammill R, Sharma P, Macdonald A. Colorectal cancer in the elderly and the influence of lead time bias: better survival does not equate with improved life expectancy. Int J Colorectal Dis 2016; 31:553-9. [PMID: 26783116 DOI: 10.1007/s00384-015-2496-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2015] [Indexed: 02/04/2023]
Abstract
AIMS Poorer outcomes in those aged ≥80 years who undergo colorectal cancer surgery have been previously reported. Little is known about the natural history of those managed non-operatively. We explored outcomes in all patients with colorectal cancer aged ≥80 years at time of diagnosis based on treatment received. METHODS Patients ≥80 years diagnosed with colorectal cancer in one hospital trust between 1998 and 2011 were identified from a prospectively maintained database. Primary endpoints were age at diagnosis, age at death/censor and mortality at 30, 90 and 365 days. RESULTS Six hundred sixty-eight patients were identified. Four hundred twelve (61.7%) underwent surgery, 44 (6.6%) received endoscopic therapy and 212 (31.7%) had no active treatment. Of those who underwent surgery, 359 (87.1%) had resectional surgery, 34 (8.3%) defunctioning only, 13 (3.2%) received bypass surgery and 6 (1.5%) had an open and close laparotomy. The mean age at diagnosis was younger in those who underwent surgical resection (83.7 years) compared to those having defunctioning surgery (84.9 years, P = 0.043), endoscopic therapy (85.1 years, P = 0.008) or no surgical intervention (85.6 years, P < 0.001). There was no significant difference in the mean age of death or censor between groups. CONCLUSIONS There was no significant difference in age at death or censor between treatment groups among patients aged ≥80 years presenting with colorectal cancer, suggesting that differences in the observed survival time are heavily influenced by lead time bias. Age at death or censor should be reported in addition to survival times in this age group to enable fair comparison of outcomes.
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Affiliation(s)
- Katrina Knight
- Department of Surgery, Monklands District General Hospital, Airdrie, North Lanarkshire, ML6 0JS, UK
| | - Raymond Oliphant
- Department of Surgery, Monklands District General Hospital, Airdrie, North Lanarkshire, ML6 0JS, UK
| | - Fraser Maxwell
- Department of Surgery, Monklands District General Hospital, Airdrie, North Lanarkshire, ML6 0JS, UK
| | - Claire McKenzie
- Department of Clinical Governance, Monklands District General Hospital, Airdrie, North Lanarkshire, ML6 0JS, UK
| | - Maria McCann
- Department of Clinical Governance, Monklands District General Hospital, Airdrie, North Lanarkshire, ML6 0JS, UK
| | - Raymond Hammill
- Department of Clinical Governance, Monklands District General Hospital, Airdrie, North Lanarkshire, ML6 0JS, UK
| | - Praveen Sharma
- Department of Surgery, Monklands District General Hospital, Airdrie, North Lanarkshire, ML6 0JS, UK
| | - Angus Macdonald
- Department of Surgery, Monklands District General Hospital, Airdrie, North Lanarkshire, ML6 0JS, UK.
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Piazzolla LP, de Almeida RM, dos Santos ACN, de Oliveira PG, da Silva EF, de Sousa JB. Does Age Influence Treatment and Oncological Outcomes in Individuals with Sporadic Colorectal Cancer? J Am Geriatr Soc 2016; 63:2190-1. [PMID: 26480984 DOI: 10.1111/jgs.13680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Luciana Paganini Piazzolla
- Postgraduate Program in Medical Sciences, Division of Surgery, School of Medicine, Coloproctology Service, Center of Surgical Clinics, Hospital Universitário de Brasília, Universidade de Brasília, Brasília, Brazil
| | - Romulo Medeiros de Almeida
- Division of Surgery, School of Medicine, Coloproctology Service, Center of Surgical Clinics, Hospital Universitário de Brasília, Universidade de Brasília, Brasília, Brazil
| | | | - Paulo Gonçalves de Oliveira
- Division of Surgery, School of Medicine, Coloproctology Service, Center of Surgical Clinics, Hospital Universitário de Brasília, Universidade de Brasília, Brasília, Brazil
| | - Eduardo Freitas da Silva
- Department of Statistics, Institute of Exact Sciences, Universidade de Brasília, Brasília, Brazil
| | - João Batista de Sousa
- Division of Surgery, School of Medicine, Coloproctology Service, Center of Surgical Clinics, Hospital Universitário de Brasília, Universidade de Brasília, Brasília, Brazil
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Dinnewitzer A, Nawara C, Augschöll C, Neureiter D, Hitzl W, Öfner D, Jäger T. The impact of advanced age on short- and long-term results after surgery for colorectal cancer. Eur Surg 2015. [DOI: 10.1007/s10353-015-0355-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ngune I, Jiwa M, McManus A, Parsons R, Hodder R. A trial of a self-assessment tool of problems following treatment of colorectal cancer: a prospective study in Australia primary care. Eur J Cancer Care (Engl) 2015; 25:69-78. [DOI: 10.1111/ecc.12340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2015] [Indexed: 11/30/2022]
Affiliation(s)
- I. Ngune
- School of Nursing and Midwifery; Faculty of Health; Engineering and Science; Edith Cowan University; Perth WA Australia
| | - M. Jiwa
- Health Innovation (Chronic Diseases); Medical Education; Curtin University; Perth WA Australia
| | - A. McManus
- Centre of Excellence for Science, Seafood & Health (CoESSH); Faculty of Health Sciences; Curtin University; Perth WA Australia
| | - R. Parsons
- School of Occupational Therapy and Social Work; Faculty of Health Sciences; Curtin University; Perth WA Australia
| | - R. Hodder
- Department of Surgery; Sir Charles Gardiner Hospital; Perth WA Australia
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Ngune I, Jiwa M, McManus A, Hughes J. Do patients with long-term side effects of cancer treatment benefit from general practitioner support? A literature review. Int J Integr Care 2015; 15:e023. [PMID: 26150761 PMCID: PMC4491325 DOI: 10.5334/ijic.1987] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 04/07/2015] [Accepted: 04/24/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Alongside specialist cancer clinics, general practitioners have an important role in cancer patients' follow-up care, yet no literature summarises the nature, extent and impact of their involvement. This paper addresses this issue through a review of the literature. METHODS Studies were sourced from six academic databases - AustHealth (n = 202), CINAHL (n = 500), the Cochrane Library (reviews and trials; n = 200), Embase (n = 368), PHCRIS (n = 132) and PubMed/Medline (n = 410). Studies that focused on interventions designed for patients receiving follow-up care and reported cancer care provided by a general practitioner delivered alongside specialist care were reviewed. RESULTS A total of 19 papers were identified as relevant for this review (3 randomised control trials; 4 cross-sectional, 5 cohort and 3 qualitative studies, and 3 systematic reviews). The reviewed studies indicated that providing general practitioner-led supportive interventions for post-treatment care of cancer patients is feasible and acceptable to patients. General practitioner involvement resulted in improved physical and psychosocial well-being of patients and continuity of care, especially for patients with concomitant health conditions. CONCLUSION Involving general practitioners in post-treatment cancer care is beneficial to patients. However, proactive initiatives that encourage and facilitate patients to consult their general practitioner about their needs or symptoms of recurrence should be considered.
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Affiliation(s)
- Irene Ngune
- Curtin University, Faculty of Health Sciences, Bentley, Perth, WA, Australia
| | - Moyez Jiwa
- Curtin University, Medical Education, Bentley, Perth, WA, Australia
| | - Alexandra McManus
- Curtin University, Faculty of Health Sciences, Bentley, Perth, WA, Australia
| | - Jeff Hughes
- Curtin University, School of Pharmacy, Bentley, Perth, WA, Australia
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Abstract
Background. The combined treatment of peritoneal carcinomatosis with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is a rigorous surgical treatment, most suitable for young and good performance status patients. We evaluated the outcomes of elderly patients undergoing CRS and HIPEC for peritoneal carcinomatosis with careful perioperative care. Methods. All consecutive patients 70 years of age or older who were treated for peritoneal carcinomatosis over the past five years were included. Primary outcomes were perioperative morbidity and mortality. Secondary outcomes were disease-free survival and overall survival. Results. From a pool of 100 patients, with a diagnosis of PC who underwent CRS and HIPEC in our center, we have included 30 patients at an age of 70 years or older and the results were compared to the patients younger than 70 years. The total morbidity rate was 50% versus 41.5% in the group younger than 70 years (NSS). The mortality rate was 3.3% in the elderly group versus 1.43% in the younger group (NSS). Median overall survival was 30 months in the older group versus 38 months in the younger group. Conclusion. Cytoreductive surgery and HIPEC for peritoneal carcinomatosis may be safely performed with acceptable morbidity in selected elderly patients.
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Meldolesi E, van Soest J, Alitto AR, Autorino R, Dinapoli N, Dekker A, Gambacorta MA, Gatta R, Tagliaferri L, Damiani A, Valentini V. VATE: VAlidation of high TEchnology based on large database analysis by learning machine. COLORECTAL CANCER 2014. [DOI: 10.2217/crc.14.34] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
SUMMARY The interaction between implementation of new technologies and different outcomes can allow a broad range of researches to be expanded. The purpose of this paper is to introduce the VAlidation of high TEchnology based on large database analysis by learning machine (VATE) project that aims to combine new technologies with outcomes related to rectal cancer in terms of tumor control and normal tissue sparing. Using automated computer bots and the knowledge for screening data it is possible to identify the factors that can mostly influence those outcomes. Population-based observational studies resulting from the linkage of different datasets will be conducted in order to develop predictive models that allow physicians to share decision with patients into a wider concept of tailored treatment.
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Affiliation(s)
- Elisa Meldolesi
- Department of Radiation Oncology, Sacred Heart University, Rome, Italy
| | - Johan van Soest
- Department of Radiation Oncology (MAASTRO) GROW School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Anna Rita Alitto
- Department of Radiation Oncology, Sacred Heart University, Rome, Italy
| | - Rosa Autorino
- Department of Radiation Oncology, Sacred Heart University, Rome, Italy
| | - Nicola Dinapoli
- Department of Radiation Oncology, Sacred Heart University, Rome, Italy
| | - Andre Dekker
- Department of Radiation Oncology (MAASTRO) GROW School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Roberto Gatta
- Department of Radiation Oncology, Sacred Heart University, Rome, Italy
| | - Luca Tagliaferri
- Department of Radiation Oncology, Sacred Heart University, Rome, Italy
| | - Andrea Damiani
- Department of Radiation Oncology, Sacred Heart University, Rome, Italy
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Abstract
The incidence of prostate cancer increases with age. Current evidence suggests that prostate cancer is under treated in patients aged ≥70 years, despite evidence of efficacy and acceptable toxicity. Radical cystectomy and definitive radiotherapy are often denied owing to fears of post-operative complications and radiotherapy-associated gastrointestinal and genitourinary toxicity. However, modern radical prostatectomy techniques provide excellent clinical outcomes with low perioperative morbidity. Moreover, volume-restricted intensity-modulated radiation therapy is a significant improvement over previous 2D conformal radiotherapy with similar efficacy and lower toxicity. Androgen-deprivation therapy is also under-prescribed among the elderly, owing to concerns of increases in cardiac deaths and osteoporosis acceleration. However, prospective trials have not identified any increase in cardiovascular mortality among elderly men receiving androgen-deprivation therapy compared to age-matched controls. Most patients on androgen deprivation eventually progress to a castration-resistant state. At this stage, the disease still responds to newer agents that target the androgen pathway and to chemotherapy. Among the elderly, chemotherapy is under-prescribed even though it has been demonstrated to be palliative and improve survival. We describe the trends in prostate cancer management in the elderly and the importance of assessing comorbidity status, tumour characteristics, and health status, including a complete geriatric evaluation, before making treatment recommendations.
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Affiliation(s)
- Gautam G Jha
- Division of Haematology, Oncology and Transplantation, University of Minnesota, MMC394, 420 Delaware Street, Minneapolis, MN 55455, USA
| | - Vidhu Anand
- Department of Urologic Surgery, University of Minnesota, MMC394, 420 Delaware Street, Minneapolis, MN 55455, USA
| | - Ayman Soubra
- Department of Urology, University of Minnesota, MMC394, 420 Delaware Street, Minneapolis, MN 55455, USA
| | - Badrinath R Konety
- Department of Urology, University of Minnesota, MMC394, 420 Delaware Street, Minneapolis, MN 55455, USA
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Ugolini G, Ghignone F, Zattoni D, Veronese G, Montroni I. Personalized surgical management of colorectal cancer in elderly population. World J Gastroenterol 2014; 20:3762-3777. [PMID: 24833841 PMCID: PMC3983435 DOI: 10.3748/wjg.v20.i14.3762] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 12/09/2013] [Accepted: 01/05/2014] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) in the elderly is extremely common but only a few clinicians are familiar with the complexity of issues which present in the geriatric population. In this phase of the life cycle, treatment is frequently suboptimal. Despite the fact that, nowadays, older people tend to be healthier than in previous generations, surgical undertreatment is frequently encountered. On the other hand, surgical overtreatment in the vulnerable or frail patient can lead to unacceptable postoperative outcomes with high mortality or persistent disability. Unfortunately, due to the geriatric patient being traditionally excluded from randomized controlled trials for a variety of factors (heterogeneity, frailty, etc.), there is a dearth of evidence-based clinical guidelines for the management of these patients. The objective of this review was to summarize the most relevant clinical studies available in order to assist clinicians in the management of CRC in the elderly. More than in any other patient group, both surgical and non-surgical management strategies should be carefully individualized in the elderly population affected by CRC. Although cure and sphincter preservation are the primary goals, many other variables need to be taken into account, such as maintenance of cognitive status, independence, life expectancy and quality of life.
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Colorectal cancer treatment and follow-up in the elderly: an inexplicably different approach. Int Surg 2014; 97:219-23. [PMID: 23113849 DOI: 10.9738/cc99.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The incidence of colorectal cancer increases as age progresses. At present, elderly patients have received substandard cancer treatment not supported by "evidence." Geriatric assessment should be performed preoperatively and selected elderly patients must be offered standard surgical treatment receiving the same complementary therapies as a younger patient. It should be stressed that elderly patients should not be deprived of their decision-making role. In our experience, more than 43% of patients with colorectal cancer are ≥70 years of age, and we believe that they should receive the same type of follow-up. This would allow for the detection and removal of polyps, treatment of malignant tumors, and psychological support similarly to younger patients. Significantly, in our experience, the incidence of reoperation for neoplastic disease is similar in the two patient populations.
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Booth CM, Tannock IF. Randomised controlled trials and population-based observational research: partners in the evolution of medical evidence. Br J Cancer 2014; 110:551-5. [PMID: 24495873 PMCID: PMC3915111 DOI: 10.1038/bjc.2013.725] [Citation(s) in RCA: 308] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- C M Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, 10 Stuart Street, Kingston, ON K7L 5PG, Canada
| | - I F Tannock
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Ploussard G, Albrand G, Rozet F, Lang H, Paillaud E, Mongiat-Artus P. Challenging treatment decision-making in older urologic cancer patients. World J Urol 2013; 32:299-308. [DOI: 10.1007/s00345-013-1158-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 08/21/2013] [Indexed: 12/27/2022] Open
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Golan T, Urban D, Berger R, Lawrence YR. Changing prognosis of metastatic colorectal adenocarcinoma: Differential improvement by age and tumor location. Cancer 2013; 119:3084-91. [PMID: 23720150 DOI: 10.1002/cncr.28143] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 02/26/2013] [Accepted: 03/25/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Over the past 2 decades, significant progress has been made in the field of metastatic colorectal cancer (mCRC) regarding new imaging techniques, surgical interventions, and systemic therapy. It is not known whether the benefit from these interventions has extended overall survival (OS) within the general mCRC population. A population-based survival analysis of newly diagnosed patients who presented with mCRC was therefore performed. METHODS Survival statistics were extracted from the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with mCRC between 1988 and 2008. Demographic variables collected included age, race, and tumor grade. Survival was analyzed using the Kaplan-Meier method and extended Cox proportional hazard model as appropriate. RESULTS The study population consisted of 42,347 patients diagnosed with mCRC between 1988 and 2008 (52% women; mean age, 67 years). The 1- and 2-year estimated OS rates were 44% and 22%, respectively. Prognostic variables included race, sex, age, tumor location, and year of diagnosis. Median OS improved from 8 months to 14 months between 1988 and 2008. Significant improvements in OS were seen for all disease sites, but especially for descending colon cancers. Whereas the median OS increased by 13 months in patients ≤50 years of age and by 7 months in patients 51-70 years of age, the median OS of patients >70 years of age increased by only 1 month between 1988 and 2008. CONCLUSIONS There has been a continuous improvement in OS of patients diagnosed with mCRC between 1988 and 2008, especially for left-sided tumors. Little improvement has been seen in patients over 70 years of age.
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Affiliation(s)
- Talia Golan
- Oncology Institute at the Chaim Sheba Medical Center, Tel-Hashomer, Israel.
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Lim M, Hussain Z, Howe A, Storey R, Petty D, Haselden J, Sebag-Montefiore D, Alexander D. The oncological outcome after right hemicolectomy and accuracy of CT scan as a preoperative tool for staging in right sided colonic cancers. Colorectal Dis 2013; 15:536-43. [PMID: 23067005 DOI: 10.1111/codi.12061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Accepted: 06/13/2012] [Indexed: 02/08/2023]
Abstract
AIM Neoadjuvant chemotherapy may have a role in the management of colonic carcinoma but clinical trials are required to determine whether this approach is superior to the standard policy of radical surgery, high-quality histopathology and selective postoperative chemotherapy. The selection of appropriate patients for such trials will depend on accurate locoregional staging of disease by preoperative CT scanning. We studied the outcome after radical right hemicolectomy and assessed the accuracy of preoperative CT scans in the prediction of postoperative pathology. METHOD A retrospective analysis of right hemicolectomies performed with curative intent for colon cancer under the care of a single colorectal surgeon (D.J.A.) was performed. Preoperative CT-proven Dukes D patients were excluded. Patient demographics, postoperative histology, use of adjuvant chemotherapy and survival data were collected. Kaplan-Meier curves were constructed and log-rank testing was performed to compare cancer-specific survival. Fifty patients had their preoperative CT scan images reviewed by two radiologists both blinded to the results of the postoperative histology. The accuracy of preoperative CT for T and N staging was studied. A P-value of < 0.05 was significant. RESULTS There were 136 patients (79 women). Median age was 76 (interquartile ratio 67-82) years. Median period of follow-up was 72 (interquartile ratio 39-92) months. There were 56 deaths (39 medical, 16 oncological and 1 postoperative). There were three groups of patients: node negative (n = 84), node positive with postoperative adjuvant chemotherapy (n = 30) and node positive without chemotherapy (n = 22). Five-year cancer-specific survival for node negative disease was 84% and was poorer for node positive patients who received adjuvant chemotherapy when compared with those who did not (62 vs 72%, P-value = 0.046 on log-rank testing). Sensitivity, specificity, positive and negative predictive value of CT scan for tumour (T) stage were 90, 33, 86 and 43% respectively, while that for nodal (N) stage was 83, 38, 57 and 69%, respectively. CONCLUSION CT scan has limited accuracy in predicting those patients with advanced locoregional disease who might benefit from neoadjuvant treatment. When this finding is combined with relatively high cancer-specific survival with surgery alone the impact of adjuvant chemotherapy on survival after radical surgery for right colon carcinoma may be marginal.
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Affiliation(s)
- M Lim
- Department of General Surgery, York District Hospital, York, UK
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45
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Dialla PO, Dabakuyo TS, Marilier S, Gentil J, Roignot P, Darut-Jouve A, Poillot ML, Quipourt V, Arveux P. Population-based study of breast cancer in older women: prognostic factors of relative survival and predictors of treatment. BMC Cancer 2012; 12:472. [PMID: 23066863 PMCID: PMC3517437 DOI: 10.1186/1471-2407-12-472] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 10/09/2012] [Indexed: 02/04/2023] Open
Abstract
Background A large proportion of women with breast cancer (BC) are elderly. However, there is a lack of information regarding BC prognostic factors and care in this population. The aims of this study were to assess the prognostic factors of relative survival (RS) among women with BC aged ≥ 75 years old and to identify the predictive factors of treatments administered to this population. Methods A population-based study was performed using data from the Cote d’Or breast and gynaecological cancer registry. Women aged 75 years and older with primary invasive BC and resident in Cote d’Or at the time of diagnosis made between January 1998 and December 2008 were retrospectively selected. Prognostic factors of RS were estimated in a generalized linear model with a Poisson error structure. RS rate for the whole population was given at 5 years. Logistic regression models were used to identify the predictors of the treatments administered. Results Six hundred and eighty-one women were included. Median age at diagnosis was 80. Comorbidities (p=0.02), pT stage (p=0.04), metastases (p=<0.001), having a family doctor (p=0.03) and hormone-receptor status (p=0.006) were independent prognostic factors of RS. The RS rate at 5 years for the whole population was 78.2%, 95%CI = [72.2-83.0]. Age, pT stage, metastases, histoprognostic SBR grade, hormone receptor status and comorbidities were frequently found to be predictors of treatment with surgery alone, hormone therapy alone, breast conserving surgery plus adjuvant therapy and mastectomy plus adjuvant therapy. Conclusions Comorbid conditions adversely affect survival in older women with breast cancer. Moreover the results of this study showed that there are numerous predictors of the type of treatment administered, and that the most important were age and comorbidities.
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Affiliation(s)
- Pegdwende Olivia Dialla
- Breast and Gynaecologic Cancer Registry of Cote d'Or, Centre Georges François Leclerc, 1 rue Professeur Marion BP 77980, Dijon Cedex 21079, France
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Mäkelä JT, Kiviniemi H. Surgical treatment of colorectal cancer in patients aged over 80 years. Int J Colorectal Dis 2012; 27:1055-60. [PMID: 22322532 DOI: 10.1007/s00384-012-1427-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to identify the clinical factors and tumour characteristics that predict the outcome in patients older than 80 years with colorectal cancer. PATIENTS AND METHODS One hundred and four patients with colorectal cancer aged over 80 years were identified from a computer database, and their clinical variables were analysed by both univariate and multivariate analyses. RESULTS All 104 patients underwent resective surgery, 87% radical and 13% palliative resection. Postoperative mortality was 5%, being associated with a number of coexisting diseases and the presence of postoperative complications, especially anastomotic leakage. The cumulative 5-year survival was 33%, the median survival was 31 months and the cancer-specific 5-year survival was 36%. The recurrence rate after radical surgery was 30%, being 13%, 25%, 44% and 100% in the Union for International Cancer Control stages I, II, III and IV. Kaplan-Meier estimates indicated that age, number of underlying diseases, radicality of operation, Dukes' staging, size of tumour, number of lymph node metastasis, metastasised disease, venous invasion and recurrent disease were significant predictors of survival, but in the Cox regression model, only venous invasion was an independent prognostic factor of survival. CONCLUSIONS Low mortality and acceptable survival can be achieved even in very elderly patients with colorectal cancer. Venous invasion is an independent predictor of survival.
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Affiliation(s)
- Jyrki T Mäkelä
- Institute of Clinical Medicine, Department of Surgery, Oulu University Hospital, PO Box 22, 90029 OYS Oulu, Finland.
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Tan KK, Koh FHX, Tan YY, Liu JZ, Sim R. Long-term outcome following surgery for colorectal cancers in octogenarians: a single institution's experience of 204 patients. J Gastrointest Surg 2012; 16:1029-36. [PMID: 22258874 DOI: 10.1007/s11605-011-1818-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 12/28/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND The incidence of colorectal cancer in elderly patients is likely to increase with an aging population. The aims of this study are to review our experience in the surgical management of octogenarians with colorectal cancers and to identify factors that influence the short-term and long-term outcomes. METHODS A retrospective review of all octogenarians who underwent surgery for colorectal cancer from December 2002 to October 2008 was performed. RESULTS We identified 204 patients with a median age of 84 years (range, 80-97 years). The majority of patients had an American Society of Anesthesiologists score ≥3 (n = 142, 69.6%) and a Charlson Comorbidity Index of ≤3 (n = 128, 62.7%). Emergency surgery was performed in 83 (40.7%) patients. Left-sided malignancy was seen in 138 patients (67.6%). Most of the patients had either stage II (n = 75, 36.8%) or III (n = 69, 33.8%) diseases. The 30-day mortality rate was 16.2% (n = 33). After multivariate analysis, the independent variables predicting worse perioperative complications and death were age >85 years old, emergency surgery, and Charlson Comorbidity Index >3. The median follow-up for the 171 remaining patients was 27 months (range, 2-92 months). The 30-day readmission rate was 2.9% (n = 5). Thirty-one (21.2%) of 146 patients who survived curative surgery developed recurrent disease. Seventy (34.3%) patients died from various etiologies after their first 30 days postoperatively (60% cancer-specific with median survival of 15 months and 40% noncancer-related with median survival of 14 months). Overall and disease-free survivals were adversely affected in patients with advanced malignancy and in those with severe perioperative complications. CONCLUSIONS Surgery for octogenarians with colorectal cancers is associated with significant morbidity and mortality rates which are associated with advanced age, emergency surgery, and Charlson Comorbidity Index >3. Long-term survival is dependent on the stage of the malignancy and the presence of severe perioperative complications.
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Affiliation(s)
- Ker-Kan Tan
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
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Jonker J, Hamaker M, Soesan M, Tulner C, Kuper I. Colon cancer treatment and adherence to national guidelines: Does age still matter? J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2011.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Maas H, Lemmens V, Cox S, Martijn H, Rutten H, Coebergh J, Janssen-Heijnen M. The effects of age and comorbidity on treatment patterns for radiotherapy and survival in patients with mobile rectal cancer: A population-based study. Eur Geriatr Med 2011. [DOI: 10.1016/j.eurger.2011.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mäkelä JT, Kiviniemi H. Clinicopathological features of colorectal cancer in patients over 70 years of age. Scand J Gastroenterol 2011; 46:1243-50. [PMID: 21718084 DOI: 10.3109/00365521.2011.598550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim was to identify the clinical factors and tumor characteristics that predict mortality and survival in patients older than 70 years with colorectal adenocarcinoma. MATERIAL AND METHODS One hundred and ninety-four patients with colorectal cancer aged over 70 years were identified from a computer database and their clinical variables were analyzed by both univariate and multivariate analyses. RESULTS All patients underwent resective surgery, 79% radical and 21% palliative resection, and postoperative mortality was 6% being associated with the presence of postoperative complications, especially anastomotic leakage. The cumulative 5-year survival was 38%, the median survival 35 months, and the cancer-specific 5-year survival 48% and this did not differ significantly between the age groups. The recurrence rate after radical surgery was 30%, being 12, 22, 56, and 100% in Dukes classes A, B, C, and D. Kaplan-Meier estimates indicated that gender, Dukes staging, grade of tumor, number of lymph node metastasis, venous invasion, and recurrent disease were significant predictors of survival, but in the Cox regression model, only venous invasion and recurrent disease were independent prognostic factors of survival. CONCLUSIONS Low mortality and acceptable survival can be achieved in elderly patients with colorectal cancer. Venous invasion and recurrent cancer are independent predictors of survival.
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Affiliation(s)
- Jyrki T Mäkelä
- Department of Surgery, Oulu University Hospital, OYS, Finland.
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