Determinants of short- and long-term survival from colorectal cancer in very elderly patients.
OBJECTIVE
Over 5100 colorectal cancers (CRCs) are diagnosed in the United Kingdom in 85 years and older age group per year but little is known of cancer progression in this group. We assessed clinical, pathological and molecular features of CRC with early and late mortality in such patients.


METHODS
Data were analysed in relation to early mortality and long-term survival in 90 consecutive patients with CRC aged 85 years or older in a single hospital.


RESULTS
Patients not undergoing operation, those with an ASA score of III or greater and those with advanced tumour stage were more likely to die within 30 days. Regression analysis showed that 30 day mortality was independently related to failure to undergo resection (odds ratio (O.R.), 10.0; 95% confidence interval [C.I.], 1.7-58.2; p=0.01) and an ASA score of III or greater (O.R. 13.0; 95% C.I., 1.4-12.6; p=0.03). All cause three and five year survival were 47% and 23% respectively for patients who are alive 30 days after diagnosis. Three and five year relative survivals were 64% and 54%, respectively. Long-term outcome was independently related to tumour stage (relative risk [R.R.], 2; 95% C.I., 1.3-3.1; p=0.001), presence of co-morbid diseases (R.R., 2.8; 95% C.I., 1.3-6.0; p=0.007) and lipid peroxidation status (R.R., 2.9; 95% C.I., 1.1-7.5; p=0.025).


CONCLUSIONS
An active multidisciplinary approach to the care of patients with CRC at the upper extreme of life is reasonable. It also seems sensible to individualise care based upon the extent of disease at diagnosis and the presence of co-morbid conditions. Further studies to examine the role of lipid peroxidation are warranted.
Centre for Colorectal Disease, St Vincent's University Hospital, University College Dublin, Elm Park, Dublin 4, Ireland. Electronic address: Juliettedoody@gmail.com.
Juliette
J
Sheridan
National Cancer Registry of Ireland, Kinsale Road, Cork, Ireland.
Paul
P
Walsh
Centre for Colorectal Disease, St Vincent's University Hospital, University College Dublin, Elm Park, Dublin 4, Ireland.
David
D
Kevans
Centre for Colorectal Disease, St Vincent's University Hospital, University College Dublin, Elm Park, Dublin 4, Ireland.
Therese
T
Cooney
Centre for Colorectal Disease, St Vincent's University Hospital, University College Dublin, Elm Park, Dublin 4, Ireland.
Shane
S
O'Hanlon
Centre for Colorectal Disease, St Vincent's University Hospital, University College Dublin, Elm Park, Dublin 4, Ireland.
Blathnaid
B
Nolan
Centre for Colorectal Disease, St Vincent's University Hospital, University College Dublin, Elm Park, Dublin 4, Ireland.
Anne
A
White
Centre for Colorectal Disease, St Vincent's University Hospital, University College Dublin, Elm Park, Dublin 4, Ireland.
Edel
E
McDermott
Centre for Colorectal Disease, St Vincent's University Hospital, University College Dublin, Elm Park, Dublin 4, Ireland.
Kieran
K
Sheahan
Centre for Colorectal Disease, St Vincent's University Hospital, University College Dublin, Elm Park, Dublin 4, Ireland.
Diarmuid
D
O'Shea
Centre for Colorectal Disease, St Vincent's University Hospital, University College Dublin, Elm Park, Dublin 4, Ireland.
John
J
Hyland
Centre for Colorectal Disease, St Vincent's University Hospital, University College Dublin, Elm Park, Dublin 4, Ireland.
Diarmuid
D
O'Donoghue
Department of Surgery, Institute of Molecular Medicine, Trinity Centre for Health Science, St. James's Hospital, Dublin 8, Ireland.
Jacintha
J
O'Sullivan
Centre for Colorectal Disease, St Vincent's University Hospital, University College Dublin, Elm Park, Dublin 4, Ireland.
Hugh
H
Mulcahy
Centre for Colorectal Disease, St Vincent's University Hospital, University College Dublin, Elm Park, Dublin 4, Ireland.
Glen
G
Doherty
D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D016017:Odds Ratio; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
Ageing; Colorectal cancer; Elderly; Lipid peroxidation; Oxidative damage; Relative survival