Bossé D, Vickers M, Lemay F, Beaudoin A
Department of Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC;
Ottawa Regional Cancer Centre, Ottawa, ON;
Curr Oncol. 2015 Oct;22(5):e349-56. doi: 10.3747/co.22.2337.
Metastatic colorectal cancer (mcrc) commonly affects elderly people, an understudied subset of patients. We analyzed the survival impact of the first and subsequent lines of chemotherapy in eligible non-trial patients 70 years of age and older with mcrc treated between 2004 and 2012.
This single-centre retrospective analysis estimated overall survival (os) and progression-free survival (pfs) using the Kaplan-Meier method. Multivariate analysis was used to adjust for age, sex, Eastern Cooperative Oncology Group performance status, score on the Charlson comorbidity index, dependency in activities of daily living, and exposure to 1 or more chemotherapy doublets, capecitabine alone, or best supportive care (bsc).
Of 109 patients identified, 29 elected bsc, and 80 received chemotherapy. In multivariate analysis, age was not associated with os [hazard ratio (hr): 0.99; 95% confidence interval (ci): 0.92 to 1.05], but a performance status of 2 or higher was associated with a decreased likelihood of survival (hr: 3.12; 95% ci: 1.87 to 5.76), and exposure to 1 or more doublets was associated with improved survival (hr: 0.33; 95% ci: 0.17 to 0.66). In univariate analysis, a trend toward improved os was observed for first-line doublet chemotherapy compared with capecitabine (hr: 0.66; 95% ci: 0.41 to 1.07), and pfs was superior (hr: 0.46; 95% ci: 0.26 to 0.84). Compared with exposure to 1 doublet, exposure to the 3 potential cytotoxic chemotherapies was not associated with improved os (hr: 0.77; 95% ci: 0.41 to 1.43). The incidence of neutropenia with first-line folfiri was 40%; the incidences of bevacizumab-related arterial and venous thrombosis were both 8%.
Exposure to 1 or more doublet chemotherapies for mcrc was associated with better outcomes in non-trial patients 70 years of age and older. Elderly patients treated with palliative chemotherapy and bevacizumab should be monitored carefully for arterial and venous thrombotic events.
转移性结直肠癌（mCRC）常见于老年人，这是一个研究较少的患者亚组。我们分析了2004年至2012年间接受治疗的70岁及以上符合条件的非试验性mCRC患者一线及后续化疗对生存的影响。
本单中心回顾性分析采用Kaplan-Meier法估计总生存期（OS）和无进展生存期（PFS）。多变量分析用于调整年龄、性别、东部肿瘤协作组体能状态、Charlson合并症指数评分、日常生活活动依赖程度以及是否接受1种或更多种化疗双联方案、单独使用卡培他滨或最佳支持治疗（BSC）。
在确定的109例患者中，29例选择了BSC，80例接受了化疗。在多变量分析中，年龄与OS无关[风险比（HR）：0.99；95%置信区间（CI）：0.92至1.05]，但体能状态为2或更高与生存可能性降低相关（HR：3.12；95%CI：1.87至5.76），且接受1种或更多种双联方案与生存改善相关（HR：0.33；95%CI：0.17至0.66）。在单变量分析中，与卡培他滨相比，一线双联化疗观察到OS有改善趋势（HR：0.66；95%CI：0.41至1.07），且PFS更优（HR：0.46；95%CI：0.26至0.84）。与接受1种双联方案相比，接受3种潜在细胞毒性化疗与OS改善无关（HR：0.77；95%CI：0.41至1.43）。一线FOLFIRI方案的中性粒细胞减少发生率为40%；贝伐单抗相关动脉和静脉血栓形成的发生率均为8%。
对于70岁及以上的非试验性mCRC患者，接受1种或更多种双联化疗与更好的预后相关。接受姑息化疗和贝伐单抗治疗的老年患者应密切监测动脉和静脉血栓形成事件。
