Chan Matthew, Hugh-Yeun Kiara, Gresham Gillian, Speers Caroline H, Kennecke Hagen F, Cheung Winson Y
British Columbia Cancer Agency, Vancouver, BC, Canada.
British Columbia Cancer Agency, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada.
Clin Colorectal Cancer. 2017 Jun;16(2):147-153. doi: 10.1016/j.clcc.2016.08.004. Epub 2016 Aug 30.
We compared the patterns and factors associated with chemotherapy and bevacizumab use in elderly versus young patients with metastatic colon cancer (mCC) and determined the effect of systemic therapy on overall survival (OS) according to age.
Patients diagnosed with mCC from 2009 to 2010 in British Columbia, Canada were reviewed and categorized as elderly patients (age ≥ 70 years) and young patients (age < 70 years). Cox regression models adjusted for age and confounders were used to determine the effect of systemic therapy on OS.
We identified 1013 patients with a median age of 67 years. Of the 1013 patients, 42% were elderly and 58% were young; 57% were men; and 66% had an Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1. Fewer elderly patients were offered systemic therapy compared with young patients (48% vs. 77%; P < .001). Among those treated, elderly patients were less likely than young patients to receive combination chemotherapy (47% vs. 81%; P < .0001) and bevacizumab (19% vs. 47%; P < .0001). The most common reasons for no treatment were similar for the elderly and young patients: patient choice, poor ECOG PS, and significant comorbidities. Advanced age alone was also cited as a reason for elderly but not for young patients (7% vs. 0%). When treated, the risk of adverse events and treatment interruptions was comparable between age groups. The receipt of systemic therapy was associated with improved OS in both elderly (hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.37-0.56; P < .0001) and young (HR, 0.43; 95% CI, 0.35-0.53; P < .0001) patients, regardless of age (interaction P > .05).
In carefully selected elderly patients, the outcomes from systemic therapy were comparable to those for young patients. Thus, age alone should not be a barrier to treatment of mCC.
我们比较了老年与年轻转移性结肠癌（mCC）患者化疗和使用贝伐单抗的模式及相关因素，并根据年龄确定了全身治疗对总生存期（OS）的影响。
回顾了2009年至2010年在加拿大不列颠哥伦比亚省诊断为mCC的患者，并将其分为老年患者（年龄≥70岁）和年轻患者（年龄<70岁）。使用针对年龄和混杂因素进行调整的Cox回归模型来确定全身治疗对OS的影响。
我们确定了1013例患者，中位年龄为67岁。在这1013例患者中，42%为老年患者，58%为年轻患者；57%为男性；66%的东部肿瘤协作组（ECOG）体能状态（PS）为0或1。与年轻患者相比，接受全身治疗的老年患者较少（48%对77%；P<.001）。在接受治疗的患者中，老年患者接受联合化疗的可能性低于年轻患者（47%对81%；P<.0001），接受贝伐单抗治疗的可能性也低于年轻患者（19%对47%；P<.0001）。老年和年轻患者未接受治疗的最常见原因相似：患者选择、ECOG PS差和严重合并症。高龄本身也被列为老年患者不接受治疗的原因，但年轻患者没有（7%对0%）。接受治疗时，各年龄组不良事件和治疗中断的风险相当。无论年龄如何，接受全身治疗均与老年患者（风险比[HR]，0.45；95%置信区间[CI]，0.37-0.56；P<.0001）和年轻患者（HR，0.43；95%CI，0.35-0.53；P<.0001）的OS改善相关（交互作用P>.05）。
在经过精心挑选的老年患者中，全身治疗的结果与年轻患者相当。因此，仅年龄不应成为mCC治疗的障碍。
