Real-world analysis of survival benefit of surgery and adjuvant therapy in elderly patients with colorectal cancer

Zhang, Lei; Li, Qixin; Hu, Chenhao; Zhang, Zhe; She, Junjun; Shi, Feiyu

doi:10.1038/s41598-023-41713-1

Cited by 6 publications

(1 citation statement)

References 37 publications

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“…Patients with localized disease aged 75–79 had an OS exceeding 70% and those aged 80–84 had an OS of over 50%, whereas the respective DSS is remarkably better (over 90% and 80%). A similar pattern among elderly CRC patients was noted in a recent study based on the SEER database [ 12 ]. That study demonstrated that elderly patients undergoing surgery usually have a better OS and DSS than those receiving palliative treatment alone.…”

Section: Discussionsupporting

confidence: 85%

Short- and Long-Term Survival among Elderly Colorectal Cancer Patients in Finland, 2006–2015: A Nationwide Population-Based Registry Study

Hukkinen,

Olenius,

Koskensalo

et al. 2023

Cancers

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This population-based registry study aimed to report 30-day and one-year postoperative survival, five-year overall survival (OS), and disease-specific survival (DSS) among elderly (≥75 years old) colorectal cancer (CRC) patients. All new colorectal cancer cases from 2006–2015 were included and followed until death or the end of follow-up (end of 2016). Among 27,088 CRC patients, 11,306 patients were ≥75 years old. Among patients ≥ 75 years, 36.8% (n = 4160) had right-sided colon cancer, 21.9% (n = 2478) left-sided colon cancer, and 32.3% (n = 3650) rectal cancer. In this study population, 932 patients were aged ≥ 90. The 30-day postoperative OS for patients aged 75–79 was 96.1% (95% confidence interval [CI] 95.3–96.9) falling to 93.2% (95% CI 92.0–94.4) for patients aged 80–84. The one-year postoperative OS among patients aged 75–79 was 86.3% (95% CI 84.7–87.9) compared with 80.5% (95% CI 78.7–82.3) among patients aged 80–84. Five-year OS among patients aged 75–79 was 47.6% (95% CI 46.0–49.2) and 36.6% (95% CI 34.8–38.4) among patients aged 80–84, compared with 61.7% (95% CI 60.9–62.5) among younger patients (<75 years old). Survival among elderly CRC patients (≥75 years old) was in general fairly good when compared with younger patients, especially among patients aged 75–79 and 80–84 with localized or locally advanced disease.

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Section: Discussionsupporting

confidence: 85%

Short- and Long-Term Survival among Elderly Colorectal Cancer Patients in Finland, 2006–2015: A Nationwide Population-Based Registry Study

Hukkinen,

Olenius,

Koskensalo

et al. 2023

Cancers

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Conditional Survival and Nomogram for Elderly Non-Metastatic Colon Cancer Patients Following Colectomy

Gao,

Wang,

Zhang

et al. 2024

Preprint

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Background: This study aimed to evaluate the conditional survival (CS) of elderly patients with non-metastatic colon cancer who underwent colectomy and build conditional nomograms that can accommodate varying survival periods and estimate survival rates. Methods: Data from 9302 patients between 2004 and 2017 were obtained from the Surveillance, Epidemiology, and End Results database. CS was used to assess overall survival and colon-specific survival rates in patients who survived beyond a certain time period. Cox regression was used to select factors for nomogram development, and performance was evaluated using area under the receiver operating characteristic curve (AUC), calibration plot, and decision curve analysis (DCA). Results: The 5-year conditional overall survival rates initially increased slightly but then decreased over time. The rates at different time points after diagnosis (baseline and 1-5 years) were 62.5, 63.2, 62.8, 62.1, 61.6, and 59.8%. In contrast, 5-year conditional colon-specific survival rates consistently improved over the same period. These rates were 78.1, 80.9, 84.2, 86.9, 89.3, and 90.9%, respectively. Nomograms were developed for baseline measurements and for patients who survived 1, 3, and 5 years. The performance of these nomograms, assessed using AUC, calibration curves, and DCA, indicated good predictive capabilities. Conclusion: CS provides valuable information on the medium- and long-term survival probabilities of elderly patients with non-metastatic colon cancer who underwent colectomy. The developed conditional nomograms allowed for the estimation of survival probabilities across different timeframes, facilitating a comprehensive understanding of prognosis and collaborative decision making.

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Prognostic impact of postoperative adjuvant chemotherapy on elderly patients with colorectal adenocarcinoma: A propensity score matching study

Huang,

Chen,

et al. 2024

J of Gastro and Hepatol

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Background and AimCurrently, the primary treatment modality for patients with colorectal adenocarcinoma (CRA) is radical surgery combined with postoperative adjuvant chemotherapy (PAC). However, many elderly patients decline PAC due to concerns about their underlying physiological condition, and the impact of PAC on the prognosis of elderly patients remains uncertain.MethodsWe extracted data from the SEER database for CRA patients aged 75 and above between 2010 and 2019. Utilizing propensity score matching (PSM), we stratified the patients into a PAC group and a non‐PAC group, enabling us to compare the differences in Kaplan–Meier survival curves between these two groups. Furthermore, through univariate and multivariate Cox regression analyses, we identified the clinical factors that influence the survival of elderly CRA patients and compared the prognostic disparities between the two patient groups within specific subgroups of these clinical factors.ResultsFollowing PSM, a total of 3668 patients were included and divided into the PAC group and the non‐PAC group, with no statistically significant differences observed in crucial clinical characteristics between the two groups. Kaplan–Meier analysis revealed a significantly better prognosis for patients in the PAC group compared with those in the non‐PAC group. In addition, age, chemotherapy, TNM staging, gender, and preoperative CEA levels were all identified as important factors affecting patient prognosis. Moreover, PAC provided survival benefits across the majority of levels within the aforementioned subgroups. However, in specific subgroups (age > 90, Grade IV stage, median household income < $40 000), PAC did not confer any survival benefits.ConclusionPAC can significantly improve the prognosis of elderly CRA patients. Nonetheless, in certain population subsets characterized by specific clinical features, PAC does not provide any survival benefits.

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Real-world analysis of survival benefit of surgery and adjuvant therapy in elderly patients with colorectal cancer

Cited by 6 publications

References 37 publications

Short- and Long-Term Survival among Elderly Colorectal Cancer Patients in Finland, 2006–2015: A Nationwide Population-Based Registry Study

Short- and Long-Term Survival among Elderly Colorectal Cancer Patients in Finland, 2006–2015: A Nationwide Population-Based Registry Study

Conditional Survival and Nomogram for Elderly Non-Metastatic Colon Cancer Patients Following Colectomy

Prognostic impact of postoperative adjuvant chemotherapy on elderly patients with colorectal adenocarcinoma: A propensity score matching study

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