80岁及以上晚期结直肠癌患者的姑息化疗
Palliative chemotherapy in advanced colorectal cancer patients 80 years of age and older.
作者信息
Lai P, Sud S, Zhang T, Asmis T, Wheatley-Price P
机构信息
University of Ottawa, Ottawa, ON;
Department of Medicine, The Ottawa Hospital, Ottawa, ON;
出版信息
Curr Oncol. 2016 Jun;23(3):144-53. doi: 10.3747/co.23.2996. Epub 2016 Jun 9.
BACKGROUND
Colorectal cancer (crc) has a median diagnostic age of 68 years. Despite significant progress in chemotherapy (ctx) options, few data on outcomes or toxicity from ctx in patients 80 years of age and older are available. We investigated ctx in such patients with metastatic crc (mcrc), hypothesizing high rates of hospitalization and toxicity.
METHODS
A retrospective chart review identified patients 80 years of age and older with mcrc who initiated ctx between 2005-2010 at our institution. Patient demographics and ctx data were collected. Endpoints included rates of hospitalization, ctx discontinuation because of toxicity, and overall survival.
RESULTS
In 60 patients, ctx was initiated on 88 occasions. Median age in the cohort was 83 years; 52% were men; 72% lived with family; 53% had a modified Charlson comorbidity index of 2 or greater; and 31% were taking 6 or more prescription medications at baseline. At baseline, 33% of the patients were anemic (hemoglobin < 100 g/L), 36% had leukocytosis (white blood cells > 11×10(9)/L), and 48% had renal impairment (estimated glomerular filtration rate < 60 mL/min/1.73 m(2)). In 53%, ctx was given as first-line treatment. The initial ctx dose was adjusted in 67%, and capecitabine was the most common chemotherapeutic agent (45%). In 19 instances (22%), the patient was hospitalized during or within 30 days of ctx; in 26 instances (30%), the ctx was discontinued because of toxicity, and in 48 instances (55%), the patient required at least 1 dose reduction, omission, or delay. Median overall survival was 17.8 months (95% confidence interval: 14.3 to 20.8 months).
CONCLUSIONS
In the population 80 years of age and older, ctx for mcrc is feasible; however, most recipients will require dose adjustments, and a significant proportion will be hospitalized or stop ctx because of toxicity. Prospective research incorporating geriatric assessment tools is required to better select these older patients for ctx.
背景
结直肠癌（CRC）的中位诊断年龄为68岁。尽管化疗（CTX）方案取得了显著进展，但关于80岁及以上患者接受CTX治疗的结局或毒性的数据却很少。我们调查了80岁及以上转移性结直肠癌（mCRC）患者的CTX治疗情况，推测其住院率和毒性发生率较高。
方法
通过回顾性病历审查，确定了2005年至2010年间在本机构开始接受CTX治疗的80岁及以上mCRC患者。收集患者的人口统计学和CTX治疗数据。观察指标包括住院率、因毒性反应而停用CTX的情况以及总生存期。
结果
60例患者共接受了88次CTX治疗。队列中的中位年龄为83岁；52%为男性；72%与家人同住；53%的改良Charlson合并症指数为2或更高；31%在基线时服用6种或更多的处方药。基线时，33%的患者贫血（血红蛋白<100g/L），36%的患者白细胞增多（白细胞>11×10⁹/L），48%的患者肾功能损害（估计肾小球滤过率<60mL/min/1.73m²）。53%的患者接受一线CTX治疗。67%的患者初始CTX剂量进行了调整，卡培他滨是最常用的化疗药物（45%）。19例患者（22%）在CTX治疗期间或治疗后30天内住院；26例患者（30%）因毒性反应而停用CTX，48例患者（55%）至少需要1次剂量减少、漏用或延迟用药。中位总生存期为17.8个月（95%置信区间：14.3至20.8个月）。
结论
在80岁及以上人群中，mCRC患者接受CTX治疗是可行的；然而，大多数接受治疗的患者需要调整剂量，且相当一部分患者会因毒性反应而住院或停止CTX治疗。需要采用老年评估工具进行前瞻性研究，以便更好地为这些老年患者选择CTX治疗方案。
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