Schiphorst Anandi H W, Verweij Norbert M, Pronk Apollo, Hamaker Marije E
1Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands 2Department of Geriatric Medicine, Diakonessenhuis, Utrecht, the Netherlands.
Dis Colon Rectum. 2014 Aug;57(8):967-75. doi: 10.1097/DCR.0000000000000145.
Care for elderly patients with low rectal cancer can pose dilemmas, because radical total mesorectal excision surgery comes with high morbidity and mortality rates.
The purpose of this study was to analyze the treatment of patients with low rectal cancer, comparing treatment choices, guideline adherence, and outcomes for elderly patients (≥75 years) with younger patients (<75 years).
Patient data were retrieved from the hospital pathology database and from the hospital prospective colorectal surgery database for surgically treated patients. Records were reviewed for nonadherence to treatment guidelines. Delivered treatment modalities for patients with stage I to III rectal cancer were compared with treatment advised by national guidelines, and reasons stated by the treating physician for nonadherence to guidelines were subsequently collected.
This study was performed at a high-volume teaching hospital.
Patients included were those with newly diagnosed rectal cancer (≤10 cm from the anal verge).
Treatment decisions, guideline adherence, and outcome of surgical treatment were the main outcome parameters.
Of 218 included patients, 75 (34%) were aged ≥75 years. Guideline adherence for all of the treatment modalities in stage I to III rectal cancer was significantly lower in elderly patients (62% versus 87% for aged <75 years; p < 0.001), and age was the primary reason mentioned for withholding treatment. Palliative anticancer treatment for stage IV disease was also initiated significantly less frequently in elderly patients (60% versus 97%; p = 0.002). Overall rates of treatment complications were similar for both patient groups (p = 0.71), but the impact of complications on survival was much greater for elderly patients (p = 0.002).
Data on outcome of other treatment modalities, such as chemotherapy and radiotherapy, are lacking.
Guideline adherence for all of the treatment modalities in stage I to III rectal cancer declines significantly with increasing age. Future research should focus on strategies of treatment tailored to patient health status rather than chronological age.
老年低位直肠癌患者的治疗可能会带来两难困境，因为根治性全直肠系膜切除术的发病率和死亡率都很高。
本研究旨在分析低位直肠癌患者的治疗情况，比较老年患者（≥75岁）和年轻患者（<75岁）的治疗选择、指南遵循情况及治疗结果。
从医院病理数据库和医院前瞻性结直肠手术数据库中检索接受手术治疗患者的资料。对不符合治疗指南的记录进行审查。将I至III期直肠癌患者接受的治疗方式与国家指南建议的治疗方式进行比较，随后收集治疗医生给出的不遵循指南的原因。
本研究在一家大型教学医院进行。
纳入的患者为新诊断的直肠癌患者（距肛缘≤10厘米）。
治疗决策、指南遵循情况及手术治疗结果是主要观察参数。
在纳入的218例患者中，75例（34%）年龄≥75岁。老年患者在I至III期直肠癌所有治疗方式上的指南遵循率显著低于年轻患者（62%对<75岁患者的87%；p<0.001），年龄是提及的不进行治疗的主要原因。老年患者中IV期疾病的姑息性抗癌治疗启动频率也显著较低（60%对97%；p = 0.002）。两组患者的总体治疗并发症发生率相似（p = 0.71），但并发症对老年患者生存的影响更大（p = 0.002）。
缺乏关于化疗和放疗等其他治疗方式结果的数据。
I至III期直肠癌所有治疗方式的指南遵循率随年龄增长显著下降。未来研究应聚焦于根据患者健康状况而非实际年龄量身定制的治疗策略。
