Risk of non‐colorectal cancer‐related death in elderly patients with the disease: A comparison of five preoperative risk assessment indices

Abstract

Background A considerable number of elderly patients with colorectal cancer (CRC) die of non‐CRC‐related causes. The Controlling Nutritional Status (CONUT) score, American Society of Anesthesiologists Physical Status classification, Charlson Comorbidity Index, National Institute on Aging, and National Cancer Institute Comorbidity Index, and Adult Comorbidity Evaluation‐27 score are all known predictors of survival in patients with CRC. However, the utility of these indices for predicting non‐CRC‐related death in elderly CRC patients is not known. Methods The study population comprised 364 patients aged 80 years or more who received curative resection for stage I–III CRC between 2000 and 2016. The association of each index with non‐CRC‐related death was compared by competing‐risks analysis such as the cumulative incidence function and proportional subdistribution hazards regression analysis as well as time‐dependent receiver‐operating characteristic (ROC) analysis. Results There were 85 deaths (40 CRC‐related and 45 non‐CRC‐related) during a median observation period of 53.2 months. Cumulative incidence function analysis identified CONUT score as the most suitable for risk stratification for non‐CRC‐related death. In proportional subdistribution hazards regression, risk of non‐CRC‐related death increased significantly as CONUT score worsened (2/3/4 vs. 0/1, hazard ratio 1.73, 95% confidence interval [CI] 0.91–3.15; ≥5 vs. 2/3/4, hazard ratio 2.71, 95% CI 1.08–6.81). Time‐dependent ROC curve analysis showed that CONUT score were consistently superior to other indices during the 5‐year observation period. Conclusions The majority of deaths in elderly patients with CRC were not CRC‐related. CONUT score was the most useful predictor of non‐CRC‐related death in these patients.

Impact of malnutrition on cancer recurrence, colorectal cancer‐specific death, and non‐colorectal cancer‐related death in patients with colorectal cancer who underwent curative surgery

“…Another important finding of the present study is that patients with low preoperative GNRI were at a higher risk of non‐CRC‐related death than patients with high preoperative GNRI in the postoperative years. Although several studies have reported an increased rate of non‐CRC‐related death in CRC patients in the postoperative years, 13–15 to the best of our knowledge, this is the first report of an increased risk of non‐CRC‐related death in CRC patients with malnutrition. This finding has at least two important clinical implications.…”

“…Another important finding of the present study is that patients with low preoperative GNRI were at a higher risk of non-CRC-related death than patients with high preoperative GNRI in the postoperative years. Although several studies have reported an increased rate of non-CRC-related death in CRC patients in the postoperative years, [13][14][15] to the best of our knowledge, this is the first report of To date, reports using the hazard function in CRC patients have shown that the RFS hazard function curve in Stages II and III CRC peaks at about 1 year after surgery, and the risk decreases thereafter. 21,22,24,25 Moreover, the peak of the hazard function curve is much more prominent for patients with Stage III CRC than those with Stage II CRC.…”

“…4,12 Given improvements in CRC survival due to medical advances, patients may now live long enough after a CRC diagnosis such that non-CRC-related death may impact their survival. 13,14 Non-cancer causes of death are major health threats for CRC survivors in the United States, and the mortality rate of noncancer death among CRC patients is more than twice the rate of that in the general population. 15 Thus, evaluating the risks of non-CRCrelated death together with CRC-specific death is crucial for making decisions about cancer treatment and postoperative surveillance.…”

“…This is not surprising because GNRI was originally developed to assess the risk of morbidity and mortality in elderly hospitalized patients 4,12 . Given improvements in CRC survival due to medical advances, patients may now live long enough after a CRC diagnosis such that non‐CRC‐related death may impact their survival 13,14 . Non‐cancer causes of death are major health threats for CRC survivors in the United States, and the mortality rate of non‐cancer death among CRC patients is more than twice the rate of that in the general population 15 .…”

A prognostic nomogram integrating carcinoembryonic antigen levels for predicting overall survival in elderly patients with stage II–III colorectal cancer

“…For traditional stage II–III CRC patients, the standard treatment is radical resection and adjuvant chemoradiotherapy ( 11 ). However, elderly CRC patients are a special category because they are older, in poorer health, have more underlying diseases and do not tolerate surgery and adjuvant chemoradiotherapy as well as younger CRC patients ( 12 , 13 ). At present, the prognostic analysis and risk factor analysis of elderly CRC patients are still lacking.…”