Goldvaser Hadar, Katz Shroitman Noa, Ben-Aharon Irit, Purim Ofer, Kundel Yulia, Shepshelovich Daniel, Shochat Tzippy, Sulkes Aaron, Brenner Baruch
Hadar Goldvaser, Irit Ben-Aharon, Ofer Purim, Yulia Kundel, Aaron Sulkes, Baruch Brenner, Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tikva 4941492, Israel.
World J Gastroenterol. 2017 Feb 28;23(8):1387-1396. doi: 10.3748/wjg.v23.i8.1387.
To characterize colorectal cancer (CRC) in octogenarians as compared with younger patients.
A single-center, retrospective cohort study which included patients diagnosed with CRC at the age of 80 years or older between 2008-2013. A control group included consecutive patients younger than 80 years diagnosed with CRC during the same period. Clinicopathological characteristics, treatment and outcome were compared between the groups. Fisher's exact test was used for dichotomous variables and was used for variables with more than two categories. Overall survival was assessed by Kaplan-Meier survival analysis, with the log-rank test. Cancer specific survival (CSS) and disease-free survival were assessed by the Cox proportional hazards model, with the Fine and Gray correction for non-cancer death as a competing risk.
The study included 350 patients, 175 patients in each group. Median follow-up was 40.2 mo (range 1.8-97.5). Several significant differences were noted. Octogenarians had a higher proportion of Ashkenazi ethnicity (64.8% 47.9%, < 0.001), a higher rate of personal history of other malignancies (22.4% 13.7%, = 0.035) and lower rates of family history of any cancer (36.6% 64.6%, < 0.001) and family history of CRC (14.4% 27.3%, = 0.006). CRC diagnosis by screening was less frequent in octogenarians (5.7% 20%, < 0.001) and presentation with performance status (PS) of 0-1 was less common in octogenarians (71% 93.9%, < 0.001). Octogenarians were more likely to have tumors located in the right colon (45.7% 34.3%, = 0.029) and had a lower prevalence of well differentiated histology (10.4% 19.3%, = 0.025). They received less treatment and treatment was less aggressive, both in patients with metastatic and non-metastatic disease, regardless of PS. Their 5-year CSS was worse (63.4% 77.6%, = 0.009), both for metastatic (21% 43%, = 0.03) and for non-metastatic disease (76% 88%, = 0.028).
Octogenarians presented with several distinct characteristics and had worse outcome. Further research is warranted to better define this growing population.
将八旬老人的结直肠癌（CRC）与年轻患者进行对比，以明确其特征。
一项单中心回顾性队列研究，纳入2008年至2013年间确诊为CRC且年龄在80岁及以上的患者。对照组包括同期确诊为CRC且年龄小于80岁的连续患者。比较两组患者的临床病理特征、治疗情况及预后。二分类变量采用Fisher精确检验，多分类变量采用 检验。采用Kaplan-Meier生存分析评估总生存期，并进行对数秩检验。采用Cox比例风险模型评估癌症特异性生存期（CSS）和无病生存期，并采用Fine和Gray校正法将非癌症死亡作为竞争风险。
该研究共纳入350例患者，每组175例。中位随访时间为40.2个月（范围1.8 - 97.5个月）。发现了一些显著差异。八旬老人中阿什肯纳兹族裔比例更高（64.8%对47.9%，P<0.001），有其他恶性肿瘤个人史的比例更高（22.4%对13.7%，P = 0.035），任何癌症家族史（36.6%对64.6%，P<0.001）和CRC家族史（14.4%对27.3%，P = 0.006）的比例更低。八旬老人通过筛查诊断CRC的频率较低（5.7%对20%，P<0.001），表现为0 - 1分体能状态（PS）的情况较少见（71%对93.9%，P<0.001）。八旬老人更易患位于右半结肠的肿瘤（45.7%对34.3%，P = 0.029），高分化组织学的患病率较低（10.4%对19.3%，P = 0.025）。无论PS如何，他们接受的治疗较少且治疗强度较低，无论是转移性疾病还是非转移性疾病患者。他们的5年CSS更差（63.4%对77.6%，P = 0.009），转移性疾病患者（21%对43%，P = 0.03）和非转移性疾病患者（76%对88%，P = 0.028）均如此。
八旬老人表现出一些独特特征且预后较差。有必要进行进一步研究以更好地界定这一不断增长的人群。
