title: Treatment of Metastatic Colorectal Cancer Patients ≥75 Years Old in Clinical Practice: A Multicenter Analysis.
abstract: BACKGROUND
  Colorectal cancer patients have a median age of incidence >65years although they are largely under-represented in phase-III trials. This large population contains patients unfit for treatment, those suitable for monotherapy or for doublets and the impact of chemotherapy outside clinical trial is unclear. The aim of the study was to retrospectively analyse Overall Survival(OS) of elderly metastatic colorectal cancer(mCRC) patients treated with chemotherapy in daily practice.
  
  
  METHODS
  Kaplan-Meir method was used for OS, the log-rank or Tarone-Ware test for differences between subgroups, Cox's proportional hazard model to assess the impact of known prognostic factors and treatment.
  
  
  RESULTS
  751 patients with mCRC observed between January 2000 and January 2013 were collected. Median age was 79 year(75-93); Male/Female 61/39%, ECOG-PS 0-1/2 85/15%; colon/rectum 74/26%; multiple metastatic sites 34%, only liver metastasis in 41% of patients. KRAS status was studied in 35% of patients: 44% of them showed gene mutation. 20.5% of patients did not received any kind of treatment including surgery. Comorbidities observed: cardiovascular 34%, diabetes 14%, hypertension 50%. Primary tumor was resected in 80.6%; surgery of liver metastasis was done in 19% of patients (2.3% of patients >80years). 78% of patients underwent chemotherapy. Median follow up was 12 months(range 1-124). Median OS was 17 months (CI 95%15-19);median OS in no-treated patients was 5 months (4-6); mOS of patients with at least one treatment was 20 months (18-22). In KRAS mutated group median OS was 19months (15-23) while in KRAS wild type patients median OS was 25 months (20-30). At multivariate analysis sex(Female), age(<80y), performance status(0-1), chemotherapy, Surgery of metastasis, Surgery of primary tumor and Site of metastasis(liver) were prognostic factors for OS.
  
  
  CONCLUSIONS
  The results of our study show that in clinical practice treatment has a positive impact on OS of elderly patients, confirmed at multivariate analysis, included patients with age >80 years old or with a poor performance status (respectively p<0.0001 and p<0.0001). KRAS analysis deserve further evaluation.
authors.affiliation: Medical Oncology Unit, ASL Frosinone, Frosinone, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Grande
authors.affiliation: Medical Oncology Unit, G. D'Annunzio University-Chieti, Chieti, Italy.
authors.forename: Clara
authors.initials: C
authors.lastname: Natoli
authors.affiliation: Medical Oncology Unit, La Sapienza University-Rome, Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Ciancola
authors.affiliation: Medical Oncology Unit, ASL Frosinone, Frosinone, Italy.
authors.forename: Donatello
authors.initials: D
authors.lastname: Gemma
authors.affiliation: Medical Oncology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy.
authors.forename: Arianna
authors.initials: A
authors.lastname: Pellegrino
authors.affiliation: Medical Oncology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy.
authors.forename: Ida
authors.initials: I
authors.lastname: Pavese
authors.affiliation: Medical Oncology Unit, Regina Elena Cancer Institute, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Garufi
authors.affiliation: Medical Oncology Unit, Regina Elena Cancer Institute, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Lauro
authors.affiliation: Medical Oncology Unit, S. Giovanni Calibita Fatebenefratelli Hospital, Isola Tiberina-Rome, Rome, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Corsi
authors.affiliation: Medical Oncology Unit, S. Giovanni Calibita Fatebenefratelli Hospital, Isola Tiberina-Rome, Rome, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Signorelli
authors.affiliation: Department of Bio-Statistics, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Isabella
authors.initials: I
authors.lastname: Sperduti
authors.affiliation: Medical Oncology Unit, G. D'Annunzio University-Chieti, Chieti, Italy.
authors.forename: Giada
authors.initials: G
authors.lastname: Cortese
authors.affiliation: Medical Oncology Unit, La Sapienza University-Rome, Rome, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Risi
authors.affiliation: Medical Oncology Unit, La Sapienza University-Rome, Rome, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Morano
authors.affiliation: Medical Oncology Unit, Regina Elena Cancer Institute, Rome, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Sergi
authors.affiliation: Medical Oncology Unit, Belcolle Hospital, Viterbo, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Signorelli
authors.affiliation: Medical Oncology Unit, Belcolle Hospital, Viterbo, Italy.
authors.forename: Enzo Maria
authors.initials: EM
authors.lastname: Ruggeri
authors.affiliation: Medical Oncology Unit ASL RM/A, Rome, Italy.
authors.forename: Germano
authors.initials: G
authors.lastname: Zampa
authors.affiliation: Medical Oncology Unit, Campus Biomedico University, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Russano
authors.affiliation: Medical Oncology Unit, ASL Frosinone, Frosinone, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Gamucci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009362:Neoplasm Metastasis; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D057216:Propensity Score