Kotake K, Asano M, Ozawa H, Kobayashi H, Sugihara K
Department of Colorectal Surgery, Tochigi Cancer Center, Utsunomiya, Japan.
Colorectal Dis. 2015 Mar;17(3):205-15. doi: 10.1111/codi.12826.
This study aimed to clarify tumour characteristics and treatment patterns for patients with colorectal cancer aged 80 years or older and the impact of age on survival using a large-scale cancer registry database.
The database was used to identify 40 851 colorectal cancer patients who underwent surgery between 1995 and 2004. Patients were stratified into four age groups (< 50, 50-64, 65-79, ≥ 80 years). Demographics, tumour characteristics, treatment pattern and survival were compared between age groups. Additionally, the impact of lymph node dissection and adjuvant chemotherapy on survival was studied using the propensity score-matching method.
In the over 80 age group, patients were more commonly female, with right colon cancer, multiple primary cancers, history of colorectal cancer, high serum carcinoembryonic antigen values, large tumour, undifferentiated histology, and more frequent pT3/pT4 tumours. In contrast, metastatic disease, central lymph node dissection and adjuvant chemotherapy were less frequent. Overall survival and cancer-specific survival decreased with increasing age for any stage. Multivariate analysis showed age to be an independent predictor of overall survival (hazard ratio 1.45, 95% CI 1.34-1.58, P < 0.001). In the propensity score-matched cohort, overall survival of the patients with central node dissection and having adjuvant chemotherapy was significantly better than for those without. This difference was not statistically significant in patients aged 80 and above.
This study showed a significant difference in tumour characteristics and treatment patterns in patients aged 80 and above. Even after adjustment for clinicopathological factors, the difference in survival persisted and age was considered a robust prognostic factor.
本研究旨在利用大规模癌症登记数据库阐明80岁及以上结直肠癌患者的肿瘤特征和治疗模式，以及年龄对生存的影响。
该数据库用于识别1995年至2004年间接受手术的40851例结直肠癌患者。患者被分为四个年龄组（<50岁、50 - 64岁、65 - 79岁、≥80岁）。比较各年龄组之间的人口统计学、肿瘤特征、治疗模式和生存率。此外，使用倾向评分匹配法研究淋巴结清扫和辅助化疗对生存的影响。
在80岁以上年龄组中，患者更常见为女性，患有右结肠癌、多原发性癌、结直肠癌病史、血清癌胚抗原值高、肿瘤大、组织学未分化，且pT3/pT4肿瘤更常见。相比之下，转移性疾病、中央淋巴结清扫和辅助化疗较少见。任何分期的总生存率和癌症特异性生存率均随年龄增加而降低。多变量分析显示年龄是总生存的独立预测因素（风险比1.45，95%可信区间1.34 - 1.58，P < 0.001）。在倾向评分匹配队列中，接受中央淋巴结清扫和辅助化疗的患者总生存率显著优于未接受者。在80岁及以上患者中，这种差异无统计学意义。
本研究显示80岁及以上患者的肿瘤特征和治疗模式存在显著差异。即使在调整临床病理因素后，生存差异仍然存在，年龄被认为是一个可靠的预后因素。
