Impact of comorbidity and frailty on prognosis in colorectal cancer patients: A systematic review and meta-analysis

Boakye, Daniel; Rillmann, B.K.; Walter, Viola; Jansen, Lina; Hoffmeister, Michael; Brenner, Hermann

doi:10.1016/j.ctrv.2018.02.003

Cited by 166 publications

(123 citation statements)

References 76 publications

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“…Our estimates are comparable to those from a meta-analysis of 5 cohort studies, which observed a 41% and 103% increased allcause mortality in patients with CRC and CCI scores of 1 to 2 and $3 compared with patients with a CCI score of 0, respectively. 32 Evidence regarding to what extent comorbidity impacts non-CRC mortality is limited. 33 In our study, comorbidity was associated with increased non-CRC mortality, and furthermore, HRs were higher than those of OS and CSS, suggesting that comorbidity affects prognosis in patients with CRC mainly through non-CRC deaths (presumably directly comorbidity-related).…”

Section: Discussionmentioning

confidence: 99%

Magnitude of the Age-Advancement Effect of Comorbidities in Colorectal Cancer Prognosis

Boakye

Walter

Jansen

et al. 2020

Journal of the National Comprehensive Cancer Network

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Background: Comorbidities and old age independently compromise prognosis of patients with colorectal cancer (CRC). The impact of comorbidities could thus be considered as conveying worse prognosis already at younger ages, but evidence is lacking on how much worsening of prognosis with age is advanced to younger ages in comorbid versus noncomorbid patients. We aimed to quantify, for the first time, the impact of comorbidities on CRC prognosis in "age advancement" of worse prognosis. Methods: A total of 4,602 patients aged $30 years who were diagnosed with CRC in 2003 through 2014 were recruited into a population-based study in the Rhine-Neckar region of Germany and observed over a median period of 5.1 years. Overall comorbidity was quantified using the Charlson comorbidity index (CCI). Hazard ratios and age advancement periods (AAPs) for comorbidities were calculated from multivariable Cox proportional hazards models for relevant survival outcomes. Results: Hazard ratios for CCI scores 1, 2, and $3 compared with CCI 0 were 1.25, 1.53, and 2.30 (P,.001) for overall survival and 1.20, 1.48, and 2.03 (P,.001) for disease-free survival, respectively. Corresponding AAP estimates for CCI scores 1, 2, and $3 were 5.0 (95% CI, 1.9-8.1), 9.7 (95% CI, 6.1-13.3), and 18.9 years (95% CI, 14.4-23.3) for overall survival and 5.5 (95% CI, 1.5-9.5), 11.7 (95% CI, 7.0-16.4), and 21.0 years (95% CI, 15.1-26.9) for disease-free survival. Particularly pronounced effects of comorbidity on CRC prognosis were observed in patients with stage I-III CRC. Conclusions: Comorbidities advance the commonly observed deterioration of prognosis with age by many years, meaning that at substantially younger ages, comorbid patients with CRC experience survival rates comparable to those of older patients without comorbidity. This first derivation of AAPs may enhance the empirical basis for treatment decisions in patients with comorbidities and highlight the need to incorporate comorbidities into prognostic nomograms for CRC.

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Section: Discussionmentioning

confidence: 99%

Magnitude of the Age-Advancement Effect of Comorbidities in Colorectal Cancer Prognosis

Boakye

Walter

Jansen

et al. 2020

Journal of the National Comprehensive Cancer Network

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“…Colorectal cancer patients with comorbid conditions are less capable to receive standard treatments due to treatment related increased side effects and toxicity; increased disabilities and geriatric syndromes. Furthermore, a comorbid condition causes the early sign and symptoms of the colorectal cancer [36].…”

Section: Discussionmentioning

confidence: 99%

Survival Status and Predictors of Mortality Among Colorectal Cancer Patients in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A Retrospective Follow-up Study

2020

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Colorectal cancer is one of the commonest cancer types that has a great public health impact both in developed and developing countries. However, in Ethiopia, the survival status of colorectal cancer patients was not well understood. Therefore, the aim of this study was to determine the survival status and predictors of mortality among colorectal cancer patients in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia in 2019. The institution-based retrospective follow-up study was conducted with 621 subjects who were selected from patients registered between January 1, 2013 and December 30, 2017 with follow-up until December 30th, 2018. Data were collected from patient record review charts. A Kaplan-Meier analysis with a log-rank test, and bivariate and multivariable analysis using the Cox proportional hazard model were used. Of the 621 colorectal cancer patients who were included in the analysis, 202 (32.5%) died. The overall mortality rate was 20.3% per year (95% CI: 17.7-23.3). The overall survival was 18.1% with median survival time of 34.8 months (95% CI: 30.4-36.8). Comorbidity (adjusted hazard ratio [AHR] = 1.

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“…More than half of the CRC patients are estimated to be frail or prefrail or have a least one comorbid condition [28], and these individuals are at increased risk of postoperative complications, poorer prognosis, treatment intolerance and death [29]. Several studies using different frailty scales have shown that higher levels of frailty are associated with increased mortality in patients with various cancers [27], including CRC [30], and may even be superior to comorbidity for predicting postoperative complications in old CRC patients [31]. However, to date no consensus or international standardization exist on how to best measure frailty in clinical settings.…”

Section: Clinical Assessments Of Biological Aging and Associations Wimentioning

confidence: 99%

Should we invest in biological age predictors to treat colorectal cancer in older adults?

Hägg

Jylhävä

2020

European Journal of Surgical Oncology

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Colorectal cancer (CRC) is a chronic disease of the old population with slow development progressing into clinical signs and symptoms. Biological aging is characterized by e.g. mitochondrial dysfunction and epigenetic alterations (e.g. methylation)-mechanisms that are also important in cancer development. For CRC, specific types of tumors are distinguishable by their methylation patterns and several detection methods using different epigenetic marks have been developed as signatures for the disease. Biological age assessed by DNA methylation patterns from blood, i.e. the epigenetic clock, is higher in CRC patients compared to controls, and may be a tool for identifying individuals at increased risk for CRC. Other types of biomarkers of aging are useful to calculate biological age, such as metabolites, protein levels, inflammatory markers and clinical biomarkers, where composite scores of biomarkers have been used to assess the risk of CRC and colorectal adenomas. Clinical assessments of biological aging includes frailty, which is a geriatric syndrome characterized by increased vulnerability to adverse outcomes. More than half of the CRC patients are estimated to be frail or pre-frail, and these individuals are at increased risk of postoperative complications, poorer prognosis, treatment intolerance and death. Hence, considering frailty as part of biological age in CRC patients may help identifying those at need of close monitoring. In summary, future screening programs for CRC may make use of biological age assessments, e.g. by epigenetic clock or composite scores. Monitoring disease relapse and treatment response should be enhanced in frail individuals for better prognosis.

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Impact of comorbidity and frailty on prognosis in colorectal cancer patients: A systematic review and meta-analysis

Cited by 166 publications

References 76 publications

Magnitude of the Age-Advancement Effect of Comorbidities in Colorectal Cancer Prognosis

Magnitude of the Age-Advancement Effect of Comorbidities in Colorectal Cancer Prognosis

Survival Status and Predictors of Mortality Among Colorectal Cancer Patients in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A Retrospective Follow-up Study

Should we invest in biological age predictors to treat colorectal cancer in older adults?

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