Cassidy Richard J, Switchenko Jeffrey M, Cheng En, Jiang Renjian, Jhaveri Jaymin, Patel Kirtesh R, Tanenbaum Daniel G, Russell Maria C, Steuer Conor E, Gillespie Theresa W, McDonald Mark W, Landry Jerome C
Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia.
Department of Biostatistics and Bioinformatics, Winship Cancer Institute of Emory University, Atlanta, Georgia.
Cancer. 2017 Nov 15;123(22):4325-4336. doi: 10.1002/cncr.30896. Epub 2017 Jul 31.
Octogenarians and nonagenarians with stage II/III rectal adenocarcinomas are underrepresented in the randomized trials that have established the standard-of-care therapy of preoperative chemoradiation followed by definitive resection (ie, chemoradiation and then surgery [CRT+S]). The purpose of this study was to evaluate the impact of therapies on overall survival (OS) for patients with stage II/III rectal cancers and determine predictors of therapy within the National Cancer Data Base (NCDB).
In the NCDB, patients who were 80 years old or older and had clinical stage II/III rectal adenocarcinoma from 2004 to 2013 were queried. Kaplan-Meier analysis, log-rank testing, logistic regression, Cox proportional hazards regression, interaction effect testing, and propensity score-matched analysis were conducted.
The criteria were met by 2723 patients: 14.9% received no treatment, 29.7% had surgery alone, 5.0% underwent short-course radiation and then surgery (RT+S), 45.3% underwent CRT+S, and 5.1% underwent surgery and then chemoradiation (S+CRT). African American race and residence in a less educated county were associated with not receiving treatment. Male sex, older age, worsening comorbidities, and receiving no treatment or undergoing surgery alone were associated with worse OS. There was no statistical difference in OS between RT+S, S+CRT, and CRT+S. Interaction testing found that CRT+S improved OS independently of age, comorbidity status, sex, race, and tumor stage. In the propensity score-matched analysis, CRT+S was associated with improved OS in comparison with surgery alone.
A significant portion of octogenarians and nonagenarians with stage II/III rectal adenocarcinomas do not receive treatment. African American race and living in a less educated community are associated with not receiving therapy. This series suggests that CRT+S is a reasonable strategy for elderly patients who can tolerate therapy. Cancer 2017;123:4325-36. © 2017 American Cancer Society.
在确立了术前放化疗然后进行根治性切除（即放化疗然后手术[CRT+S]）这一标准治疗方案的随机试验中，患有II/III期直肠腺癌的八旬和九旬老人的代表性不足。本研究的目的是评估治疗对II/III期直肠癌患者总生存期（OS）的影响，并在国家癌症数据库（NCDB）中确定治疗的预测因素。
在NCDB中，查询了2004年至2013年80岁及以上且患有临床II/III期直肠腺癌的患者。进行了Kaplan-Meier分析、对数秩检验、逻辑回归、Cox比例风险回归、交互作用检验和倾向评分匹配分析。
2723例患者符合标准：14.9%未接受治疗，29.7%仅接受手术，5.0%接受短程放疗然后手术（RT+S），45.3%接受CRT+S，5.1%接受手术然后放化疗（S+CRT）。非裔美国人种族以及居住在教育程度较低的县与未接受治疗相关。男性、年龄较大、合并症加重以及未接受治疗或仅接受手术与较差的总生存期相关。RT+S、S+CRT和CRT+S之间的总生存期无统计学差异。交互作用检验发现，CRT+S可独立于年龄、合并症状态、性别、种族和肿瘤分期改善总生存期。在倾向评分匹配分析中，与仅手术相比，CRT+S与总生存期改善相关。
相当一部分患有II/III期直肠腺癌的八旬和九旬老人未接受治疗。非裔美国人种族以及生活在教育程度较低的社区与未接受治疗相关。本系列研究表明，CRT+S对于能够耐受治疗的老年患者是一种合理的策略。《癌症》2017年；123:4325-36。©2017美国癌症协会。
