Aparicio Thomas, Navazesh Atika, Boutron Isabelle, Bouarioua Nadia, Chosidow Denis, Mion Mathieu, Choudat Laurence, Sobhani Iradj, Mentré France, Soulé Jean Claude
Service d'Hépato-Gastroentérologie, AP-HP, Hôpital Bichat, Université Denis Diderot, Paris 7, UFR de Médecine, Paris, France.
Crit Rev Oncol Hematol. 2009 Sep;71(3):249-57. doi: 10.1016/j.critrevonc.2008.11.006. Epub 2009 Jan 7.
Several database studies report a lack of care in elderly patients with colorectal cancer.
To describe the management of elderly patients admitted for colorectal cancer; to identify factors associated with standard management according to recommendations and to study factors influencing the survival.
All consecutive patients over 75 years managed for a colorectal adenocarcinoma in our hospital from 1995 to 2000 and followed until 2006 were retrospectively included. The appropriateness of the management of their disease according to the recommendations available at that time was assessed. Several risk factors in receiving the standard cancer treatment were tested using univariate and then multivariate logistic regression. Risk factors of survival were studied using univariate and then multivariate survival analysis.
One hundred and ten patients were included. Median age was 82 years (range: 75-96). A surgical treatment was performed in 96 patients. The median overall survival was 32 (1-108) months. A standard cancer treatment according to recommendations was performed in 53 (48%) patients: adjuvant chemotherapy in 6/23 patients with stage III tumour, palliative chemotherapy in 3/18 patients with stage IV tumour and adjuvant radiotherapy in 4/14 patients who had a rectal tumour resection. Multivariate analysis retains tumour stage I or II (OR=7.6, 95% C.I.=[2.9-19.9], p<0.0001) as the only factor associated with standard treatment and presence of metastasis (HR=3.9, 95% C.I. [1.4-10.8], p=0.005), and Charlson's score >3 (HR=28.9, 95% C.I. [2.5-335.6], p=0.001) as independent risk factors of poor survival.
Fifty two percent of elderly patients have had a sub-standard cancer treatment. The majority had a surgical treatment, but only a few received chemotherapy or radiotherapy. Metastasis, older age and Charlson's comorbidity score are the main prognosis factors of poor survival.
多项数据库研究报告称老年结直肠癌患者存在治疗不足的情况。
描述老年结直肠癌住院患者的治疗情况；根据推荐标准确定与规范治疗相关的因素，并研究影响生存的因素。
回顾性纳入1995年至2000年在我院接受治疗的所有75岁以上连续性结直肠腺癌患者，并随访至2006年。根据当时可用的推荐标准评估其疾病治疗的合理性。使用单因素分析，然后多因素逻辑回归分析检测接受标准癌症治疗的多个危险因素。使用单因素分析，然后多因素生存分析研究生存危险因素。
纳入110例患者。中位年龄为82岁（范围：75 - 96岁）。96例患者接受了手术治疗。中位总生存期为32（1 - 108）个月。53例（48%）患者接受了符合推荐标准的癌症治疗：23例III期肿瘤患者中有6例接受辅助化疗，18例IV期肿瘤患者中有3例接受姑息化疗，14例接受直肠肿瘤切除的患者中有4例接受辅助放疗。多因素分析确定肿瘤I期或II期（OR = 7.6，95%可信区间=[2.9 - 19.9]，p < 0.0001）是与规范治疗相关的唯一因素，而存在转移（HR = 3.9，95%可信区间[1.4 - 10.8]，p = 0.005）以及Charlson评分>3（HR = 28.9，95%可信区间[2.5 - 335.6]，p = 0.001）是生存不良的独立危险因素。
52%的老年患者接受了不规范的癌症治疗。大多数患者接受了手术治疗，但只有少数患者接受了化疗或放疗。转移、高龄和Charlson合并症评分是生存不良的主要预后因素。
