Elderly patients with colon cancer have unique tumor characteristics and poor survival

Abstract

BACKGROUND:The incidence of colon cancer increases with age, and colon cancer predominantly affects individuals >65 years old. However, there are limited data regarding clinical and pathologic factors, treatment characteristics, and survival of older patients with colon cancer. The objective of this study was to determine the effects of increasing age on colon cancer. METHODS: Patients diagnosed with colon cancer between 1988 and 2006 were identified through the Los Angeles County Cancer Surveillance Program, in Southern California. Patients were stratified into 4 age groups: 18-49, 50-64, 65-79, and !80 years. Clinical and pathologic characteristics and disease-specific and overall survival were compared between patients from different age groups. RESULTS: A total of 32,819 patients were assessed. Patients aged 18 to 49 and 65 to 79 years represented the smallest and largest groups, respectively. A near equal number of males and females were diagnosed with colon cancer in the 3 youngest age groups, whereas patients who were !80 years old were more commonly white and female. Tumor location was different between groups, and the frequency of larger tumors (>5 cm) was greatest in youngest patients (18-49 years). The oldest patients (!80 years) were administered chemotherapy at the lowest frequency, and disease-specific and overall survival rates decreased with increasing age. CONCLUSIONS: This investigation demonstrates that older age is associated with alterations in clinical and pathologic characteristics and decreased survival. This suggests that the phenotype of colon cancer and the efficacy of colon cancer therapies may be dependent on the age of patients. Cancer 2013;119:739-47.

Octogenarian patients with colorectal cancer: Characterizing an emerging clinical entity.

“…In contrast to other studies [5,6] , CRC among octogenarians had no female predominance. The ethnic composition was considerably different between the two groups.…”

“…In agreement with previous reports [5][6][7] , we found that octogenarians had clear predilection for right colon tumors. This finding might suggest a distinct pathogenesis of CRC among older patients, such as a higher rate of MMR deficiency or its phenotype, MSI-H tumors.…”

“…While some studies imply that elderly patients with CRC might have unique features [5][6][7] as well as worse outcome [7][8][9] , these findings are not consistent [1013] . Elderly patients are considerably underrepresented in clinical trials [14,15] .…”

“…As the median age at diagnosis of CRC is 68 [2] , similar to some recent studies [5,6,16] we chose a cut off of 80 years old in order to emphasize agerelated characteristics.…”

Feasibility of Modified FOLFOX in Elderly Patients Aged ≥80 Years with Metastatic Gastric Cancer or Colorectal Cancer

“…Older age was associated with high presentation of ascending colon cancer, a clear decrease in chemotherapy administration, and decreased survival [22] . Also, the lack of established treatment guidelines for elderly patients may be an important reason for their underrepresentation.…”