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Agaciak M, Wassie MM, Simpson K, Cock C, Bampton P, Fraser R, Symonds EL. Surveillance colonoscopy findings in asymptomatic participants over 75 years of age. JGH Open 2024; 8:e13071. [PMID: 38699472 PMCID: PMC11062249 DOI: 10.1002/jgh3.13071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/06/2024] [Accepted: 04/12/2024] [Indexed: 05/05/2024]
Abstract
Background and Aim Surveillance colonoscopy for colorectal cancer (CRC) is generally not recommended beyond 75 years of age. The study determined incidence and predictors of advanced adenoma and CRC in older individuals undergoing surveillance colonoscopy. Methods This was a retrospective cohort study of asymptomatic older participants (≥75 years), enrolled in a South Australian CRC surveillance program who underwent colonoscopy (2015-2020). Clinical records were extracted for demographics, personal or family history of CRC, comorbidities, polypharmacy, and colonoscopy findings. The associations between clinical variables and advanced adenoma or CRC at surveillance were assessed with multivariable Poisson regression analysis. Results Totally 698 surveillance colonoscopies were analyzed from 574 participants aged 75-91 years (55.6% male). The incidence of CRC was 1.6% (11/698), while 37.9% (260/698) of procedures had advanced adenoma detected. Previous CRC (incidence rate ratio [IRR] 5.9, 95% CI 1.5-22.5), age ≥85 years (IRR 5.8, 95% CI 1.6-20.1) and active smoking (IRR 4.9, 95% CI 1.0-24.4) were independently associated with CRC diagnosis, while advanced adenoma at immediately preceding colonoscopy (IRR 1.6, 95% CI 1.3-2.0) and polypharmacy (IRR 1.2, 95% CI 1.0-1.5) were associated with advanced adenoma at surveillance colonoscopy in asymptomatic older participants (≥75 years). Conclusion Advanced neoplasia was found in more than one third of the surveillance procedures completed in this cohort. Continuation of surveillance beyond age 75 yeasrs may be considered in participants who have previous CRC or are active smokers (provided they are fit to undergo colonoscopy). In other cases, such as past advanced adenoma only, the need for ongoing surveillance should be considered alongside participant preference and health status.
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Affiliation(s)
- Madelyn Agaciak
- Department of Medicine, College of Medicine and Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Molla M Wassie
- Flinders University, College of Medicine and Public HealthFlinders Health and Medical Research Institute, AdelaideBedford ParkSouth AustraliaAustralia
| | - Kalindra Simpson
- Department of Gastroenterology and HepatologyFlinders Medical CentreBedford ParkSouth AustraliaAustralia
| | - Charles Cock
- Flinders University, College of Medicine and Public HealthFlinders Health and Medical Research Institute, AdelaideBedford ParkSouth AustraliaAustralia
- Department of Gastroenterology and HepatologyFlinders Medical CentreBedford ParkSouth AustraliaAustralia
| | - Peter Bampton
- Department of Gastroenterology and HepatologyFlinders Medical CentreBedford ParkSouth AustraliaAustralia
| | - Robert Fraser
- Flinders University, College of Medicine and Public HealthFlinders Health and Medical Research Institute, AdelaideBedford ParkSouth AustraliaAustralia
- Department of Gastroenterology and HepatologyFlinders Medical CentreBedford ParkSouth AustraliaAustralia
| | - Erin L Symonds
- Flinders University, College of Medicine and Public HealthFlinders Health and Medical Research Institute, AdelaideBedford ParkSouth AustraliaAustralia
- Department of Gastroenterology and HepatologyFlinders Medical CentreBedford ParkSouth AustraliaAustralia
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Du R, Guo J, Li J, Lyu J, Lyu L. Competitive Risk Analysis of Prognosis in Older Adults with Sigmoid Colon Adenocarcinoma: A Population-Based Study. Cancer Control 2024; 31:10732748241262184. [PMID: 38868954 PMCID: PMC11179461 DOI: 10.1177/10732748241262184] [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: 03/15/2024] [Revised: 05/20/2024] [Accepted: 05/26/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND The purpose of this study is to employ a competing risk model based on the Surveillance, Epidemiology, and End Results (SEER) database to identify prognostic factors for elderly individuals with sigmoid colon adenocarcinoma (SCA) and compare them with the classic Cox proportional hazards model. METHODS We extracted data from elderly patients diagnosed with SCA registered in the SEER database between 2010 and 2015. Univariate analysis was conducted using cumulative incidence functions and Gray's test, while multivariate analysis was performed using both the Fine-Gray and Cox proportional hazards models. RESULTS Among the 10,712 eligible elderly patients diagnosed with SCA, 5595 individuals passed away: 2987 due to sigmoid colon adenocarcinoma and 2608 from other causes. The results of one-way Gray's test showed that age, race, marital status, AJCC stage, differentiation grade, tumor size, surgical status, liver metastasis status, lung metastasis status, brain metastasis status, radiotherapy status, and chemotherapy status all affected the prognosis of SCA (P < .05). Multivariate analysis showed that sex, age, race, marital status, and surgical status affected the prognosis of SCA (P < .05). Multifactorial Fine-Gray analysis revealed that key factors influencing the prognosis of SCA patients include age, race, marital status, AJCC stage, grade classification, surgical status, tumor size, liver metastasis, lung metastasis, and chemotherapy status (P < .05). CONCLUSION Data from the SEER database were used to more accurately estimate CIFs for sigmoid colon adenocarcinoma-specific mortality and prognostic factors using competing risk models.
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Affiliation(s)
- Ruofei Du
- Department of Geriatrics, Southern University of Science and Technology Hospital, Shenzhen, China
- School of Public Health, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Jiayu Guo
- School of Public Health, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Jing Li
- School of Public Health, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, China
| | - Li Lyu
- Department of Geriatrics, Southern University of Science and Technology Hospital, Shenzhen, China
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Dalmat RR, Ziebell RA, Kamineni A, Phipps AI, Weiss NS, Breslau ES, Burnett-Hartman AN, Corley DA, Doria-Rose VP, Green BB, Halm EA, Levin TR, Schottinger JE, Chubak J. Risk of Colorectal Cancer and Colorectal Cancer Mortality Beginning One Year after a Negative Fecal Occult Blood Test, among Screen-Eligible 76- to 85-Year-Olds. Cancer Epidemiol Biomarkers Prev 2023; 32:1382-1390. [PMID: 37450838 PMCID: PMC10592334 DOI: 10.1158/1055-9965.epi-23-0265] [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: 03/21/2023] [Revised: 06/05/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Colorectal cancer screening is universally recommended for adults ages 45 to 75 years. Noninvasive fecal occult blood tests are effective screening tests recommended by guidelines. However, empirical evidence to inform older adults' decisions about whether to continue screening is sparse, especially for individuals with prior screening. METHODS This study used a retrospective cohort of older adults at three Kaiser Permanente integrated healthcare systems (Northern California, Southern California, Washington) and Parkland Health. Beginning 1 year following a negative stool-based screening test, cumulative risks of colorectal cancer incidence, colorectal cancer mortality (accounting for deaths from other causes), and non-colorectal cancer mortality were estimated. RESULTS Cumulative incidence of colorectal cancer in screen-eligible adults ages 76 to 85 with a negative fecal occult blood test 1 year ago (N = 118,269) was 0.23% [95% confidence interval (CI), 0.20%-0.26%] after 2 years and 1.21% (95% CI, 1.13%-1.30%) after 8 years. Cumulative colorectal cancer mortality was 0.03% (95% CI, 0.02%-0.04%) after 2 years and 0.33% (95% CI, 0.28%-0.39%) after 8 years. Cumulative risk of death from non-colorectal cancer causes was 4.81% (95% CI, 4.68%-4.96%) after 2 years and 28.40% (95% CI, 27.95%-28.85%) after 8 years. CONCLUSIONS Among 76- to 85-year-olds with a recent negative stool-based test, cumulative colorectal cancer incidence and mortality estimates were low, especially within 2 years; death from other causes was over 100 times more likely than death from colorectal cancer. IMPACT These findings of low absolute colorectal cancer risk, and comparatively higher risk of death from other causes, can inform decision-making regarding whether and when to continue colorectal cancer screening beyond age 75 among screen-eligible adults.
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Affiliation(s)
- Ronit R. Dalmat
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Rebecca A. Ziebell
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Amanda I. Phipps
- Department of Epidemiology, University of Washington, Seattle, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Noel S. Weiss
- Department of Epidemiology, University of Washington, Seattle, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Erica S. Breslau
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | | | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway Street, Oakland, CA, USA
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - V. Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Beverly B. Green
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Kaiser Permanente Bernard J Tyson School of Medicine, Department of Health Systems Science, Pasadena, CA
| | - Ethan A. Halm
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Theodore R. Levin
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway Street, Oakland, CA, USA
- Department of Gastroenterology, Kaiser Permanente Medical Center, Walnut Creek, CA USA
| | - Joanne E. Schottinger
- Kaiser Permanente Bernard J Tyson School of Medicine, Department of Health Systems Science, Pasadena, CA
| | - Jessica Chubak
- Department of Epidemiology, University of Washington, Seattle, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Ma Q, Li H, Jiang Y, Wang Y, Liang J. Oncological and surgical outcomes of radical surgery in elderly colorectal cancer patients with intestinal obstruction. Front Surg 2023; 10:1251461. [PMID: 37675249 PMCID: PMC10477695 DOI: 10.3389/fsurg.2023.1251461] [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: 07/01/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023] Open
Abstract
Background The treatment strategy for elderly colorectal cancer patients with intestinal obstruction remains controversial. The choice of reasonable treatment and surgical method directly affects perioperative safety and prognosis. This study investigated the safety and long-term efficacy of radical surgery in elderly colorectal cancer patients over 80 years old with intestinal obstruction. Methods The clinicopathological data of elderly patients over 80 years old with intestinal obstruction who underwent colorectal cancer surgery from January 2012 to December 2021 were retrospectively collected and analysed. Patients were assigned to a radical group and a palliative group according to the surgical method. Propensity score matching (PSM) was performed to match patients in the radical group 1:1 with those in the palliative group. The perioperative-related indexes and prognosis were compared between the two groups. Results A total of 187 patients were enrolled in this study. After PSM, 58 matched pairs were selected, and the radical and palliative groups were well balanced in terms of the clinical and surgical characteristics (P > 0.05). The proportion of patients transferred to the ICU after surgery in the radical group was significantly higher than that in the palliative group (17.2% vs. 5.2%, P = 0.039). In terms of postoperative complications, the incidence of grade 1-5 complications in the radical group was significantly higher than that in the palliative group (37.9% vs. 15.5%, P = 0.006); however, there was no significant difference in the incidence of grade 3-5 complications between the two groups (6.9% vs. 1.7%, P = 0.364). In addition, the complications were subclassified, and it was found that the incidence of gastrointestinal disorders (20.7% vs. 6.9%, P = 0.031) after surgery was significantly higher in the radical group. The 3-year OS rates were 55.2% and 22.6% in the radical and palliative groups, respectively (P < 0.001). Multivariate analysis revealed that radical surgery was an independent prognostic factor for OS (HR: 4.32; 95% CI, 1.93-12.45; P < 0.001). Conclusion Although elderly colorectal cancer patients over 80 years of age with intestinal obstruction are more likely to be admitted to the ICU and develop more postoperative complications after radical surgery, long-term survival benefits can be achieved.
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Affiliation(s)
- Qingbiao Ma
- Department of General Surgery, Liaoyang Central Hospital, Liaoyang, China
| | - Hongyu Li
- Department of General Surgery, Liaoyang Central Hospital, Liaoyang, China
| | - Yujuan Jiang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yingfei Wang
- Department of General Surgery, Liaoyang Central Hospital, Liaoyang, China
| | - Jianwei Liang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Lieberman D. At What Age Should We Stop Colorectal Cancer Screening? When Is Enough, Enough? Cancer Epidemiol Biomarkers Prev 2023; 32:6-8. [PMID: 36620899 DOI: 10.1158/1055-9965.epi-22-1006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/01/2022] [Accepted: 11/22/2022] [Indexed: 01/10/2023] Open
Abstract
There is strong evidence that colorectal cancer screening can reduce both colorectal cancer incidence and mortality. Guidelines recommend screening for individuals age 45 to 75 years, but are less certain about the benefits after age 75 years. Dalmat and colleagues provide evidence that individuals with a prior negative colonoscopy 10 years or more prior to reaching age 76 to 85 years, had a low risk of colorectal cancer, and would be less likely to benefit from further screening. It is important to note that this study population did not include individuals with a family history of colon cancer or a personal history of having high-risk adenomas. These data suggest that a negative colonoscopy can be an effective risk-stratification tool when discussing further screening with elderly patients. See related article by Dalmat et al., p. 37.
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Affiliation(s)
- David Lieberman
- Division of Gastroenterology and Hepatology, Oregon Health and Science University L461, Portland, Oregon
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