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Okamoto K, Nozawa H, Emoto S, Murono K, Sasaki K, Ishihara S. Adjuvant chemotherapy for elderly patients with colorectal cancer: a single-centre observational study in Japan. J Chemother 2024; 36:319-328. [PMID: 37881011 DOI: 10.1080/1120009x.2023.2273096] [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: 05/08/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023]
Abstract
Adjuvant chemotherapy improves the prognosis of patients with colorectal cancer (CRC) following radical resection. The aim of the present study is to review appropriate chemotherapeutic regimens for elderly patients. We examined 1138 Japanese patients who were operated for high-risk stage II or stage III CRC between July 2010 and June 2021 at our hospital. Patients were divided according to an age of 70 years. The efficacy of adjuvant therapy was analyzed in association with age and adjuvant chemotherapeutic regimens. A total of 507 patients (45%) were ≥70 years old. They were less likely to receive adjuvant chemotherapy (p < 0.001) or palliative chemotherapy after recurrence (p < 0.001) than patients aged <70 years. Cancer-specific survival (CSS) in stage III CRC patients was longer in the <70 years group than in the ≥70 years group (p = 0.006); however, CSS by regimens did not significantly differ between these groups. Adjuvant chemotherapy was associated with the longer relapse-free survival of stage III CRC patients in the <70 years group (p = 0.005). Although adjuvant chemotherapy was associated with a favourable CSS regardless of age, the implementation rate of adjuvant chemotherapy for elderly CRC patients was low, which may explain shorter CSS in stage III CRC patients the ≥70 years group than in the <70 years group.
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Affiliation(s)
- Kazuaki Okamoto
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Koji Murono
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
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Gefen R, Emile SH, Garoufalia Z, Horesh N, Dourado J, Wexner SD. Local versus radical resection of stage I-III rectal cancer in very elderly patients: an exact matched analysis of the national cancer database. J Gastrointest Surg 2024:S1091-255X(24)00478-5. [PMID: 38815802 DOI: 10.1016/j.gassur.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/13/2024] [Accepted: 05/25/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Treatment of elderly cancer patients is challenging as they can be over-treated with respect to frailty or under-treated due to advanced age. Maintaining a good quality of life is essential for this population. This study aimed to assess the difference in overall survival and short-term outcomes according to extent of rectal cancer resection in patients aged ≥80 years. METHODS In this retrospective cohort study, very elderly patients with stage I-III rectal cancer aged ≥80 years were identified from the National Cancer Database (2004-2019). Patients were divided into two groups: radical resection and local excision. The groups were matched using exact matched analysis for clinical T and N stage, tumor size, and neoadjuvant treatment. Main outcome measures were overall survival, hospital stay, 30-day unplanned readmissions, and short-term mortality. RESULTS 9634 patients were included (local excision = 2710; radical resection = 6924). After matching, 1106 patients were included in each group with a median follow-up of 49.9 and 51.7 months, respectively. The radical resection group had statistically significantly longer overall survival than did local excision (60 vs. 57.2 months, p=0.026). Local excision was associated with shorter length of stay (1 vs. 7 days. p<0.001), lower 30-day mortality (Odds ratio: 0.43; 95%CI: 0.25- 0.75, p=0.003), lower 90-day mortality (Odds ratio: 0.47, 95%CI: 0.32- 0.68, p<0.001), and lower 30-day readmission (Odds ratio: 0.49, 95%CI: 0.33- 0.74, p<0.001). A subgroup analysis of matched patients with cTis-T2, N0 tumors who underwent curative surgery, revealed similar results. CONCLUSIONS Radical resection of rectal cancer in very elderly patients had a modest survival benefit whereas local excision had lower odds of readmission and short-term mortality.
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Affiliation(s)
- Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA; Department of General Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA; Colorectal Surgery Unit, Mansoura University Hospital, Mansoura University, Egypt
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
| | - Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA; Department of surgery and transplantations, Sheba Medical center, Ramat Gan, Israel
| | - Justin Dourado
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA.
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Piercey O, Wong HL, Leung C, To YH, Heong V, Lee M, Tie J, Steel M, Yeung JM, McCormick J, Gibbs P, Wong R. Adjuvant Chemotherapy for Older Patients With Stage III Colorectal Cancer: A Real-World Analysis of Treatment Recommendations, Treatment Administered and Impact on Cancer Recurrence. Clin Colorectal Cancer 2024; 23:95-103.e3. [PMID: 38242766 DOI: 10.1016/j.clcc.2024.01.001] [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: 07/10/2023] [Revised: 11/23/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND A substantial proportion of patients with stage III colorectal cancer (CRC) are older than 70 years. Optimal adjuvant chemotherapy (AC) for older patients (OP) continues to be debated, with subgroup analyses of randomized trials not demonstrating a survival benefit from the addition of oxaliplatin to a fluoropyrimidine backbone. PATIENTS AND METHODS We analyzed the multisite Australian ACCORD registry, which prospectively collects patient, tumor and treatment data along with long term clinical follow-up. We compared OP (≥70) with stage III CRC to younger patients ([YP] <70), including the proportion recommended AC and any reasons for not prescribing AC. AC administration, regimen choice, completion rates, and survival outcomes were also examined. RESULTS One thousand five hundred twelve patients enrolled in the ACCORD registry from 2005 to 2018 were included. Median follow-up was 57.0 months. Compared to the 827 YP, the 685 OP were less likely to be offered AC (71.5% vs. 96.5%, P < .0001) and when offered, were more likely to decline treatment (15.1% vs. 2.8%, P < .0001). Ultimately, 60.0% of OP and 93.7% of YP received AC (P < .0001). OP were less likely to receive oxaliplatin (27.5% vs. 84.7%, P < .0001) and to complete AC (75.9% vs. 85.7%, P < .0001). The probability of remaining recurrence-free was significantly higher in OP who received AC compared to those not treated (HR 0.73, P = .04) but not significantly improved with the addition of oxaliplatin (HR 0.75, P = .18). CONCLUSION OP were less likely than YP to receive AC. Receipt of AC reduced recurrences in OP, supporting its use, although no significant benefit was observed from the addition of oxaliplatin.
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Affiliation(s)
- Oliver Piercey
- Peter MacCallum Cancer Centre, Melbourne, Australia; The University of Melbourne, Parkville, Australia.
| | - Hui-Li Wong
- Peter MacCallum Cancer Centre, Melbourne, Australia; The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Clara Leung
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Yat Hang To
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Valerie Heong
- The University of Melbourne, Parkville, Australia; The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Margaret Lee
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia; Eastern Health, Box Hill, Australia; Western Health, St Albans, Australia; Monash University, Eastern Health Clinical School, Box Hill, Australia
| | - Jeanne Tie
- Peter MacCallum Cancer Centre, Melbourne, Australia; The University of Melbourne, Parkville, Australia; The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | | | - Justin M Yeung
- The University of Melbourne, Parkville, Australia; Western Health, St Albans, Australia
| | - Jacob McCormick
- Peter MacCallum Cancer Centre, Melbourne, Australia; Melbourne Health, Parkville, Australia
| | - Peter Gibbs
- The University of Melbourne, Parkville, Australia; The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia; Western Health, St Albans, Australia
| | - Rachel Wong
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia; Eastern Health, Box Hill, Australia; Monash University, Eastern Health Clinical School, Box Hill, Australia
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Gefen R, Emile SH, Horesh N, Garoufalia Z, Wexner SD. Age-related variations in colon and rectal cancer: An analysis of the national cancer database. Surgery 2023; 174:1315-1322. [PMID: 37735035 DOI: 10.1016/j.surg.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/24/2023] [Accepted: 08/08/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Characteristics of colorectal diseases may vary according to the patient's age. By using a large national database, we assessed age-related differences in characteristics and treatments of colorectal cancer and to evaluate the influence of age on outcomes. METHOD Retrospective cohort analysis of all patients who underwent surgical resection for colorectal cancer in the US National Cancer Database between 2005 and 2019. Patients were divided into 3 age groups: young age onset (<50 years), middle age group (50-79 years), and very old (≥80 years). Differences in tumor characteristics among groups were assessed. The main outcomes were clinical and treatment characteristics and short-term mortality. RESULTS In total, 662,102 patients with colon cancer and 114,460 with rectal cancer were included-36.1% of young patients with colon cancer presented with metastatic disease. Older patients underwent open surgery more often and received chemotherapy and radiation therapy less often than did the other 2 groups regarding disease stage. Very old patients, compared to middle-aged and young patients, had longer hospitalization and significantly higher rates of 30-day mortality after colon (7.6% vs 2.4% vs 0.7%; P < .001) and rectal (5.9% vs 1.3% vs 0.3%; P < .001) cancer surgery and higher 90-day mortality after colon (12.9% vs 4.6% vs 1.7% P < .001) and rectal (10.3% vs 2.6% vs 0.7%; P < .001) cancer surgery.Older patients had significantly shorter overall survival than the other 2 groups, regardless of pathologic stage, Charlson -Deyo comorbidity score, or tumor side. CONCLUSION Significant age-related disparities in characteristics, treatments, and outcomes of colorectal cancer were found in this study. Recognizing these differences can be the first step toward reducing age-related treatment differences.
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Affiliation(s)
- Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Department of General Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel. https://twitter.com/RachellGefen
| | - Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Colorectal Surgery Unit, Mansoura University Hospital, Mansoura University, Egypt. https://twitter.com/dr_samehany81
| | - Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, Israel. https://twitter.com/nirhoresh
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL. https://twitter.com/ZGaroufalia
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL.
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Sgouros J, Gkoura S, Spathas N, Tzoudas F, Karampinos K, Miaris N, Visvikis A, Dessypris N, Mauri D, Aravantinos G, Theodoropoulos I, Stamoulis G, Samantas E. INCIDENCE OF DISEASE RECURRENCE IN PATIENTS WITH COLON AND UPPER RECTUM ADENOCARCINOMA STAGE II AND III RECEIVING ADJUVANT CAPECITABINE MONOTHERAPY: DO NUMBER OF CHEMOTHERAPY CYCLES AND RELATIVE DOSE INTENSITY OF THE DRUG PLAY A ROLE? Clin Colorectal Cancer 2023; 22:238-244. [DOI: 10.1016/j.clcc.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
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Shiraishi T, Ogawa H, Shioi I, Ozawa N, Osone K, Okada T, Sohda M, Shirabe K, Saeki H. Differences in prognosis and underuse of adjuvant chemotherapy between elderly and non-elderly patients in stage III colorectal cancer. Ann Gastroenterol Surg 2022; 7:91-101. [PMID: 36643370 PMCID: PMC9831896 DOI: 10.1002/ags3.12604] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/06/2022] [Indexed: 01/18/2023] Open
Abstract
Aim We aimed to clarify the use of adjuvant chemotherapy and the prognosis of elderly colorectal cancer patients compared with non-elderly patients, and the usefulness of sarcopenia as an indicator for the introduction and completion of adjuvant chemotherapy. Methods Between 2013 and 2021, 215 patients with pStage III disease were included. We investigated perioperative clinicopathological factors, adjuvant chemotherapy details, and prognosis. Preoperative sarcopenia status was evaluated using computed tomography images. Elderly patients were defined as those aged ≥70 years. Results We included 121 (56.3%) and 94 (43.7%) non-elderly and elderly patients, respectively. Among the elderly patients, 47 had sarcopenia. There were no significant differences in the incompletion rate of adjuvant chemotherapy between elderly and non-elderly patients (27.1%/16.2%, P = 0.119). The most common reason for the discontinuation of adjuvant chemotherapy was side effects, regardless of age. The respective 3-year-disease free survival of patients with no/completed/incomplete adjuvant chemotherapy were 65.5%, 80.2%, and 57.7% for non-elderly patients (P = 0.045) and 73.4%, 70.6%, and 71.6% for elderly patients (P = 0.924). The number of elderly patients with sarcopenia was significantly higher in patients without adjuvant chemotherapy (P = 0.004) and those with incomplete adjuvant chemotherapy (P = 0.004). The 3-year-disease free survival of elderly sarcopenic patients without and with adjuvant chemotherapy were 78.3% and 59.2%, respectively (P = 0.833). Conclusion Elderly patients did not show a benefit of adjuvant chemotherapy regardless of whether they had completed adjuvant chemotherapy, unlike non-elderly patients. Moreover, the evaluation of preoperative sarcopenia in elderly colorectal cancer patients may be useful in determining the indication for adjuvant chemotherapy.
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Affiliation(s)
- Takuya Shiraishi
- Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashiJapan
| | - Hiroomi Ogawa
- Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashiJapan
| | - Ikuma Shioi
- Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashiJapan
| | - Naoya Ozawa
- Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashiJapan
| | - Katsuya Osone
- Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashiJapan
| | - Takuhisa Okada
- Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashiJapan
| | - Makoto Sohda
- Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashiJapan
| | - Ken Shirabe
- Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashiJapan
| | - Hiroshi Saeki
- Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashiJapan
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Nöpel-Dünnebacke S, Jütte H, Denz R, Feder IS, Kraeft AL, Lugnier C, Teschendorf C, Collette D, Böhner H, Engel L, Mueller L, Hartmann F, Kaiser U, Bruch HR, Hollerbach S, Arnold D, Timmesfeld N, Tannapfel A, Reinacher-Schick A. Causes of mortality in elderly UICC stage III colon cancer (CC) patients--Tumor-related death and competing risks from the German AIO colorectal study group Colopredict Plus (CPP) registry. Cancer Med 2022; 11:1735-1744. [PMID: 35146948 PMCID: PMC9041084 DOI: 10.1002/cam4.4540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/21/2021] [Accepted: 11/11/2021] [Indexed: 12/23/2022] Open
Abstract
Background Colon cancer (CC) is a disease of elderly patients (pts.) with a median age of 73 years (yrs.). Lack of data about the effects of adjuvant chemotherapy (ACT) is caused by underrepresentation of this clinically relevant cohort in interventional trials. We analyzed real‐world data from the German CPP registry with regard to a possible benefit of ACT in elderly (70+ yrs.) versus younger pts. (50 to <70 yrs.) taking cause‐specific deaths into account. Methods We analyzed the effect of age and ACT on overall survival (OS) and cause‐specific death of stage III pts. using Cox regression. Results In total, 1558 pts. were analyzed and follow‐up was 24.6 months. 62.6% of the elderly received ACT whereas 91.1% of younger pts. (p < 0.001). Oxaliplatin combinations were significantly less often given to older than younger pts. (38.8% vs. 88.9%; p < 0.001). Mean Charlson comorbidity score was significantly lower in pts. that received ACT (0.61) than in those without ACT (1.16; p < 0.001). ACT was an independent positive prognostic factor for cancer‐related death in elderly pts. even in pts. 75+ yrs. No significant difference in the effect of ACT could be observed between age groups (interaction: cancer‐specific death HR = 1.7948, p = 0.1079; death of other cause HR = 0.7384, p = 0.6705). Conclusion ACT was an independent positive prognostic factor for OS. There may be a cohort of elderly with less co‐morbidities who benefit from ACT.
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Affiliation(s)
- Stefanie Nöpel-Dünnebacke
- Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Hendrick Jütte
- Institute of Pathology, Ruhr-University Bochum, Bochum, Germany
| | - Robin Denz
- Department of Medical Informatics, Biometrics and Epidemiology, Ruhr-University, Bochum, Germany
| | | | - Anna-Lena Kraeft
- Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Celine Lugnier
- Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital Bochum, Ruhr-University, Bochum, Germany
| | | | - Daniela Collette
- Joint Practice of Hematology and Oncology, Catholic Hospital Dortmund West, Dortmund, Germany
| | - Hinrich Böhner
- Department of General and Visceral Surgery, Catholic Hospital Dortmund West, Germany
| | - Lars Engel
- Department of General and Visceral Surgery, Paracelsus Medical University, Hospital Nürnberg Nord, Nürnberg, Germany
| | | | - Frank Hartmann
- Department of Oncology and Hematology, Klinikum Lippe, Lemgo, Germany
| | - Ulrich Kaiser
- Department of Hematology, Oncology and Palliative Care, St. Bernsward Hospital, Hildesheim, Germany
| | | | | | - Dirk Arnold
- Department of Oncology, Hematology and Palliative Care, Asklepios Hospital, Cancer Center Altona, Hamburg, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometrics and Epidemiology, Ruhr-University, Bochum, Germany
| | | | - Anke Reinacher-Schick
- Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital Bochum, Ruhr-University, Bochum, Germany
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Chen W, Dong H, Wang G, Chen J, Wang W. Effect of the duration of the capecitabine regimen following colon cancer surgery in an elderly population: a retrospective cohort study. World J Surg Oncol 2021; 19:238. [PMID: 34380513 PMCID: PMC8359119 DOI: 10.1186/s12957-021-02348-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/28/2021] [Indexed: 12/16/2022] Open
Abstract
Background Only 50–70% of elderly colon cancer patients could complete the recommended 6 months of postoperative chemotherapy. It is unknown whether a shorter duration of postoperative capecitabine-alone chemotherapy would compromise survival. We thus conducted this study to analyze the association between postoperative chemotherapy duration of a capecitabine-alone regimen and cancer-specific survival (CSS) and disease-free survival (DFS) of surgery-treated elderly colon cancer patients. Methods We performed a retrospective cohort study of surgically treated stage III and high-risk stage II colon cancer patients aged ≥ 70 treated at two medical centers. Cox proportional hazard regression models were utilized to calculate crude and adjusted hazard ratios (HRs). The nonlinear relationship between postoperative chemotherapy duration and survival was analyzed through restricted cubic spline regression analysis, and the threshold effect was calculated by the two-piecewise Cox proportional hazard model. Results A total of 1217 surgery-treated colon cancer patients between August 1, 2013, and September 1, 2019, were reviewed, and 257 stage III and high-risk stage II patients aged ≥ 70 were enrolled. Postoperative chemotherapy with capecitabine was administered to 114 patients, and 143 patients only received surgery. As the duration of chemotherapy increased by 1 week, the risk of cancer-specific death was reduced by 11% (HR = 0.89, 95% confidence interval (CI) 0.82–0.96), and the risk of recurrence was reduced by 10% (HR = 0.90, 0.82–0.96). Nonlinearity exploration suggested a threshold effect of capecitabine duration on CSS in stage III disease. The HR for death was 0.79 (95% CI, 0.68–0.92) with duration ≤ 16 weeks and 1.34 (95% CI, 0.91–1.97) with duration > 16 weeks. Conclusions The postoperative capecitabine duration was significantly associated with a decrease in death risk and recurrence risk in elderly colon cancer patients. However, the threshold effect of capecitabine duration on survival suggests that short-term chemotherapy may improve survival in elderly stage III colon cancer patients.
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Affiliation(s)
- Weiwei Chen
- Department of Clinical Medicine, Guizhou Medical University, Guiyang, China.,Department of Abdominal Oncology, Guizhou Province Cancer Hospital, Guiyang, China
| | - Hongmin Dong
- Department of Abdominal Oncology, Guizhou Province Cancer Hospital, Guiyang, China.,Department of Oncology, Affiliated Hospital of Guizhou Medical University, No. 1 Beijing West Road, Guiyang, Guizhou, 550001, China
| | - Gang Wang
- Department of Abdominal Oncology, Guizhou Province Cancer Hospital, Guiyang, China.,Department of Oncology, Affiliated Hospital of Guizhou Medical University, No. 1 Beijing West Road, Guiyang, Guizhou, 550001, China
| | - Juan Chen
- Department of Clinical Medicine, Guizhou Medical University, Guiyang, China.,Department of Abdominal Oncology, Guizhou Province Cancer Hospital, Guiyang, China
| | - Wenling Wang
- Department of Abdominal Oncology, Guizhou Province Cancer Hospital, Guiyang, China. .,Department of Oncology, Affiliated Hospital of Guizhou Medical University, No. 1 Beijing West Road, Guiyang, Guizhou, 550001, China.
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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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Recurrence Risk after Radical Colorectal Cancer Surgery-Less Than before, But How High Is It? Cancers (Basel) 2020; 12:cancers12113308. [PMID: 33182510 PMCID: PMC7696064 DOI: 10.3390/cancers12113308] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/27/2020] [Accepted: 11/06/2020] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Evidence indicates that recurrence risk after colon cancer today is less than it was when trials performed decades ago showed that adjuvant chemotherapy reduces the risk and prolong disease-free and overall survival. After rectal cancer surgery, local recurrence rates have decreased but it is unclear if systemic recurrences have. After a systematic review of available literature reporting recurrence risks after curative colorectal cancer surgery we report that the risks are lower today than they were in the past and that this risk reduction is not solely ascribed to the use of adjuvant therapy. Adjuvant therapy always means overtreatment of many patients, already cured by the surgery. Fewer recurrences mean that progress in the care of these patients has happened but also that the present guidelines giving recommendations based upon old data must be adjusted. The relative gains from adding chemotherapy are not altered, but the absolute number of patients gaining is less. Abstract Adjuvant chemotherapy aims at eradicating tumour cells sometimes present after radical surgery for a colorectal cancer (CRC) and thereby diminish the recurrence rate and prolong time to recurrence (TTR). Remaining tumour cells will lead to recurrent disease that is usually fatal. Adjuvant therapy is administered based upon the estimated recurrence risk, which in turn defines the need for this treatment. This systematic overview aims at describing whether the need has decreased since trials showing that adjuvant chemotherapy provides benefits in colon cancer were performed decades ago. Thanks to other improvements than the administration of adjuvant chemotherapy, such as better staging, improved surgery, the use of radiotherapy and more careful pathology, recurrence risks have decreased. Methodological difficulties including intertrial comparisons decades apart and the present selective use of adjuvant therapy prevent an accurate estimate of the magnitude of the decreased need. Furthermore, most trials do not report recurrence rates or TTR, only disease-free and overall survival (DFS/OS). Fewer colon cancer patients, particularly in stage II but also in stage III, today display a sufficient need for adjuvant treatment considering the burden of treatment, especially when oxaliplatin is added. In rectal cancer, neo-adjuvant treatment will be increasingly used, diminishing the need for adjuvant treatment.
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