University of Liverpool, St Helens Teaching Hospital, Department of Surgery, Marshalls Cross Road, St Helens, Liverpool WA9 3DA, UK.
Nat Rev Gastroenterol Hepatol. 2012 Dec;9(12):716-25. doi: 10.1038/nrgastro.2012.196. Epub 2012 Oct 9.
Colorectal cancer (CRC) largely affects older individuals; almost half of cases occur in patients >75 years old. The incidence increases with advancing age, doubling every 7 years in patients aged ≥50 years. The medical and societal burdens of CRC will probably worsen over the coming decades as the number of older individuals (>70) continues to grow. No evidence-based guidelines are available for this age group, as older patients with CRC are generally excluded from randomized clinical trials and the fit ones who are recruited are not representative of the general elderly population. When feasible, surgery is the most successful treatment option for eradicating the primary lesion, as well as any metastases. The operative risk under elective conditions is not markedly different in older than in younger patients; however, the acute setting is to be avoided as it is associated with high operative death rates. Well-selected older patients can tolerate chemotherapy, but benefits need to be balanced against potentially limited life expectancy and reduced quality of life. The use of combination chemotherapy is an area of much controversy, but this treatment should not necessarily be withheld because of the age of the patient. Careful monitoring of toxicities and early intervention is essential in older patients undergoing chemotherapy.
结直肠癌（CRC）主要影响老年人；近一半的病例发生在>75 岁的患者中。发病率随年龄增长而增加，≥50 岁的患者每 7 年增加一倍。随着>70 岁的老年人数量不断增加，CRC 的医疗和社会负担可能在未来几十年内恶化。由于 CRC 老年患者通常被排除在随机临床试验之外，而招募的合适患者也不能代表一般老年人群，因此针对该年龄组尚无循证指南。在可行的情况下，手术是根除原发性病变和任何转移灶的最成功治疗选择。在选择性条件下，老年患者的手术风险与年轻患者没有明显差异；然而，应避免急性治疗，因为它与高手术死亡率相关。精心挑选的老年患者可以耐受化疗，但需要权衡潜在的有限预期寿命和降低的生活质量。联合化疗的使用存在很大争议，但不应因患者年龄而拒绝这种治疗。在接受化疗的老年患者中，必须仔细监测毒性并及早干预。
