Hoshino Nobuaki, Kawada Kenji, Hida Koya, Goto Saori, Uozumi Ryuji, Hasegawa Suguru, Sugihara Kenichi, Sakai Yoshiharu
Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Med Oncol. 2017 Aug;34(8):138. doi: 10.1007/s12032-017-0996-0. Epub 2017 Jul 11.
One of the reasons for the underuse of adjuvant chemotherapy in elderly patients with stage III colorectal cancer is a small survival benefit. This retrospective study sought to identify the predictive factors for elderly patients who could obtain a sufficient survival benefit. We reviewed the data of 1354 elderly patients (aged ≥70 years) with stage III colorectal cancer who underwent complete resection between January 1997 and December 2006. The efficacy of adjuvant chemotherapy was assessed, and the risk factors for recurrence were determined. The efficacy of adjuvant chemotherapy was also assessed after stratification for the above-mentioned risk factors for recurrence. There was a tendency for adjuvant chemotherapy to be effective in elderly patients (hazard ratio 0.84; 95% CI 0.70-1.01). Age, tumor location, pathology findings, tumor depth, venous invasion and lymph node metastasis were identified to be independent risk factors for recurrence by univariate and multivariate analyses. Among these factors, adjuvant chemotherapy was much effective in the elderly patients with high venous invasion (v2-3) (hazard ratio 0.69; 95% CI 0.52-0.91). High venous invasion (v2-3) was identified to be a predictive factor for elderly patients with stage III colorectal cancer who gained a sufficient survival benefit.
老年III期结直肠癌患者辅助化疗使用率低的原因之一是生存获益较小。这项回顾性研究旨在确定能获得足够生存获益的老年患者的预测因素。我们回顾了1997年1月至2006年12月期间1354例接受了根治性切除的老年III期结直肠癌患者（年龄≥70岁）的数据。评估了辅助化疗的疗效，并确定了复发的危险因素。在根据上述复发危险因素进行分层后，也评估了辅助化疗的疗效。辅助化疗在老年患者中似乎有效果（风险比0.84；95%可信区间0.70 - 1.01）。通过单因素和多因素分析确定年龄、肿瘤位置、病理结果、肿瘤深度、静脉侵犯和淋巴结转移是复发的独立危险因素。在这些因素中，辅助化疗在静脉侵犯程度高（v2 - 3）的老年患者中效果显著（风险比0.69；95%可信区间0.52 - 0.91）。静脉侵犯程度高（v2 - 3）被确定为能获得足够生存获益的老年III期结直肠癌患者的一个预测因素。
