title: Efficacy of surgery and adjuvant therapy in older patients with colorectal cancer: a STROBE-compliant article.
abstract: The present study aimed to assess the efficacy of surgery and adjuvant therapy in older patients (age≥70 years) with colorectal cancer (CRC). Older CRC patients are under-represented in available clinical trials, and therefore their outcomes after receiving surgery and adjuvant therapy are unclear. From two prospective Swedish databases, we assessed a cohort of 1021 patients who underwent curative surgery for stage I, II, or III primary CRC, with or without adjuvant chemotherapy/radiotherapy. Of the patients with colon cancer (n=467), 182 (39%) were aged <70 years, 162 (35%) aged 70 to 80 years, and 123 (26%) were aged ≥80 years. Of rectal cancer patients (n=554), 264 (48%) were aged <70 years, 234 (42%) aged 70 to 80 years, and 56 (10%) aged ≥80 years. Older patients with either colon or rectal cancer had higher comorbidity than did younger patients. Older patients with colon cancer had equivalent postoperative morbidity and 30-day mortality to younger patients. Rectal cancer patients aged ≥80 years had a higher 30-day mortality than younger patients (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.6-4.55; P=0.03). For either colon or rectal cancer, adjuvant chemotherapy compromised the 5-year overall survival (OS) of older patients with stage II disease and had no effect on those with stage III disease. Receiving adjuvant chemotherapy was a poor factor of OS for older patients with either colon (HR 1.88, 95% CI: 1.20-4.35, P=0.03) or rectal cancer (HR 1.72, 95% CI: 1.05-2.26, P=0.004). Preoperative short-course radiotherapy improved both OS and local control for older patients with stage III rectal cancer and had no effect on those with stage II disease. Radiotherapy was a favorable factor for the OS of the older patients with rectal cancer (HR 0.42, 95% CI: 0.21-3.57, P=0.01). In conclusion, Older CRC patients had equal safety of surgery as younger patients, except rectal cancer patients aged ≥80 years that had a higher mortality. Adjuvant 5FU-based chemotherapy did not benefit older CRC patient, while neoadjuvant radiotherapy improved the prognosis of older patients with stage III rectal cancer.
authors.affiliation: From the Institute of Digestive Surgery and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China (LY, QM, Y-YY, CW, W-JM, YL, Z-GZ, X-FS); Department of Oncology and Department of Clinical and Experiment Medicine, Linköping University, Linköping, Sweden (GA, MA, X-FS); Department of Surgery in Östergötland, Norrköping, Sweden (GA); Department of Pathology, Jönköping Hospital, Jönköping, Sweden (IJ); and Department of General Surgery, Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai, China (Z-HP).
authors.forename: Lie
authors.initials: L
authors.lastname: Yang
authors.forename: Qin
authors.initials: Q
authors.lastname: Ma
authors.forename: Yong-Yang
authors.initials: YY
authors.lastname: Yu
authors.forename: Cun
authors.initials: C
authors.lastname: Wang
authors.forename: Wen-Jian
authors.initials: WJ
authors.lastname: Meng
authors.forename: Gunnar
authors.initials: G
authors.lastname: Adell
authors.forename: Maria
authors.initials: M
authors.lastname: Albertsson
authors.forename: Gunnar
authors.initials: G
authors.lastname: Arbman
authors.forename: Ingvar
authors.initials: I
authors.lastname: Jarlsfelt
authors.forename: Zhi-Hai
authors.initials: ZH
authors.lastname: Peng
authors.forename: Yuan
authors.initials: Y
authors.lastname: Li
authors.forename: Zong-Guang
authors.initials: ZG
authors.lastname: Zhou
authors.forename: Xiao-Feng
authors.initials: XF
authors.lastname: Sun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003082:Colectomy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents