Merchant Shaila J, Nanji Sulaiman, Brennan Kelly, Karim Safiya, Patel Sunil V, Biagi James J, Booth Christopher M
Department of Oncology, Queen's University, Kingston, Ontario, Canada.
Department of Surgery, Queen's University, Kingston, Ontario, Canada.
Cancer. 2017 Aug 1;123(15):2840-2849. doi: 10.1002/cncr.30691. Epub 2017 Mar 27.
Clinical trials have established surgical resection and adjuvant chemotherapy (ACT) as the standard management for stage III colon cancer; however, the extent to which these results apply to elderly patients in routine practice is unclear. This article describes the management and outcomes of elderly patients with stage III colon cancer.
All cases of surgically resected colon cancer from 2002 to 2008 were identified with the population-based Ontario Cancer Registry. Pathology reports were obtained for a random sample (25% of all cases); those with stage III disease constituted the study population. The utilization of ACT, cancer-specific survival (CSS), and overall survival (OS) in elderly patients (≥70 years) and nonelderly patients (<70 years) were compared.
The study population included 2920 patients, and 1521 (52%) were elderly. The 30- and 90-day mortality rates increased with advanced age: <70 years, 2% and 5%; 70 to 74 years, 3% and 7%; 75 to 79 years, 5% and 8%, and ≥80 years, 9% and 16% (P < .001). ACT was delivered to 48% of elderly patients and to 81% of younger patients (P < .001). Factors independently associated with ACT utilization among the elderly were a younger age (P < .001), male sex (P = .041), and no comorbidities (P = .001). Among elderly patients, ACT was associated with improved CSS (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.60-0.88) and OS (HR, 0.71; 95% CI, 0.60-0.83); however, the magnitude of the benefit was smaller for elderly patients than younger patients (HR for CSS, 0.53; 95% CI, 0.42-0.67; HR for OS 0.56; 95% CI, 0.45-0.69).
Half of elderly patients with stage III colon cancer do not receive ACT. Although the effect size is smaller than that in younger patients, ACT is associated with improved long-term survival. Cancer 2017;123:2840-49. © 2017 American Cancer Society.
临床试验已将手术切除及辅助化疗（ACT）确立为Ⅲ期结肠癌的标准治疗方案；然而，这些结果在常规临床实践中适用于老年患者的程度尚不清楚。本文描述了老年Ⅲ期结肠癌患者的治疗及预后情况。
利用基于人群的安大略癌症登记处识别出2002年至2008年所有接受手术切除的结肠癌病例。随机抽取样本（占所有病例的25%）获取病理报告；Ⅲ期疾病患者构成研究人群。比较老年患者（≥70岁）和非老年患者（<70岁）ACT的使用情况、癌症特异性生存（CSS）及总生存（OS）。
研究人群包括2920例患者，其中1521例（52%）为老年患者。30天和90天死亡率随年龄增长而升高：<70岁，分别为2%和5%；70至74岁，分别为3%和7%；75至79岁，分别为5%和8%；≥80岁，分别为9%和16%（P<.001）。48%的老年患者接受了ACT，而年轻患者这一比例为81%（P<.001）。老年患者中与ACT使用独立相关的因素包括年龄较轻（P<.001）、男性（P = .041）及无合并症（P = .001）。在老年患者中，ACT与CSS改善相关（风险比[HR]，0.73；95%置信区间[CI]，0.60 - 0.88）及OS改善相关（HR，0.71；95% CI，0.60 - 0.83）；然而，老年患者的获益程度小于年轻患者（CSS的HR为0.53；95% CI，0.42 - 0.67；OS的HR为0.56；95% CI，0.45 - 0.69）。
半数老年Ⅲ期结肠癌患者未接受ACT。尽管效应大小小于年轻患者，但ACT与长期生存改善相关。《癌症》2017年；123：2840 - 49。©2017美国癌症协会
