title: Is Chemotherapy or Radiation Therapy in Addition to Surgery Beneficial for Locally Advanced Rectal Cancer in the Elderly? A National Cancer Data Base (NCDB) Study.
abstract: BACKGROUND
  Current National Comprehensive Cancer Network guidelines for Stages II and III rectal cancer recommend neoadjuvant chemoradiation followed by curative intent surgery and adjuvant chemotherapy. It is unclear whether therapies in addition to surgery are truly beneficial in elderly patients. Our aim was to compare the survival of patients over 80 with Stages II and III rectal cancer undergoing curative intent surgery with or without additional therapy.
  
  
  METHODS
  The National Cancer Data Base (NCDB 2006-2011) was queried for patients over 80 with Stages II and III rectal cancer. The primary outcome was overall survival. Patients were stratified based upon therapy group. Univariate group comparisons were made. Unadjusted Kaplan-Meier and multivariable Cox proportional hazards modeling survival analyses were performed.
  
  
  RESULTS
  The query yielded 3098 patients over 80 with Stage II (N = 1566) or Stage III (N = 1532) disease. Approximately, half of the patients received surgery only. Kaplan-Meier analysis showed improved survival for patients receiving neoadjuvant and/or adjuvant therapy in addition to surgery, but there was no significant difference between those that received guideline concordant care (GCC), neoadjuvant chemoradiation only, or post-operative chemotherapy only. Cox proportional hazard modeling identified age >90 and margin positivity as independent risk factors for decreased overall survival.
  
  
  CONCLUSIONS
  Analysis of NCDB data for Stages II and III rectal cancer in patients over 80 shows a survival benefit of adjuvant and/or neoadjuvant therapy over surgery alone. There does not appear to be a difference in survival between patients who received neoadjuvant chemoradiation, post-resection adjuvant chemotherapy, or GCC.
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN, USA. bergquist.john@mayo.edu.|Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA. bergquist.john@mayo.edu.
authors.forename: J R
authors.initials: JR
authors.lastname: Bergquist
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN, USA.|Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Thiels
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN, USA.|Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
authors.forename: C R
authors.initials: CR
authors.lastname: Shubert
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
authors.forename: E B
authors.initials: EB
authors.lastname: Habermann
authors.affiliation: Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, OR, USA.
authors.forename: A V
authors.initials: AV
authors.lastname: Hayman
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN, USA.|Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.|Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: M D
authors.initials: MD
authors.lastname: Zielinski
authors.affiliation: Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA. mathis.kellie@mayo.edu.
authors.forename: K L
authors.initials: KL
authors.lastname: Mathis
mesh_terms: D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant / Q000401:mortality; D017024:Chemotherapy, Adjuvant / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D020360:Neoadjuvant Therapy / Q000401:mortality; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D015996:Survival Rate