Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.
Colorectal Dis. 2017 Oct;19(10):O358-O364. doi: 10.1111/codi.13876.
According to established guidelines, patients with Stage III colon cancer should receive adjuvant chemotherapy. However, a significant proportion do not. This study assessed factors associated with the administration of adjuvant chemotherapy and causes of death.
Patients with Stage III colon cancer who underwent surgery between 2000 and 2009 were selected from two hospitals in the Netherlands. Patient characteristics including comorbidities and treatment preferences, tumour characteristics and follow-up were extracted from the medical records. The patient and tumour characteristics of patients who did receive chemotherapy were compared with those who did not using chi-squared analysis. Differences between the groups in causes of death were recorded together with the duration of follow-up.
A total of 348 patients were included. The median age was 73 years (range 33-93). Over half of the patients received adjuvant chemotherapy (50.6%). Patients who did not receive adjuvant chemotherapy were significantly older (P < 0.001), had more comorbidities (P < 0.001) and were more often living alone (P < 0.001). Patients who received no adjuvant chemotherapy had a reduced overall survival, and the cause of death was more often attributed to other causes (60%) than colon cancer (40%). For patients who received chemotherapy, the cause of death was usually attributed to colon cancer (71%).
Patients who did not receive adjuvant chemotherapy had a worse overall survival and the majority died due to other causes than colon cancer. In our aging society it will become even more important to develop tools to estimate remaining life expectancy in order to improve the selection of older patients for adjuvant treatments.
根据既定指南，III 期结肠癌患者应接受辅助化疗。然而，很大一部分患者并未接受化疗。本研究评估了与辅助化疗实施相关的因素及死亡原因。
从荷兰的两家医院中选择 2000 年至 2009 年间接受手术治疗的 III 期结肠癌患者。从病历中提取患者特征（包括合并症和治疗偏好）、肿瘤特征和随访情况。采用卡方检验比较接受化疗和未接受化疗患者的特征。记录死亡原因和随访时间。
共纳入 348 例患者。患者的中位年龄为 73 岁（范围 33-93 岁）。超过一半的患者接受了辅助化疗（50.6%）。未接受辅助化疗的患者年龄显著更大（P<0.001）、合并症更多（P<0.001）、独居的情况更多（P<0.001）。未接受辅助化疗的患者总生存时间更短，且死亡原因更多归因于其他原因（60%）而非结肠癌（40%）。接受化疗的患者中，死亡原因通常归因于结肠癌（71%）。
未接受辅助化疗的患者总生存时间更差，且大多数患者死于结肠癌以外的其他原因。在老龄化社会中，开发工具来评估剩余预期寿命将变得更加重要，以便改进对老年患者辅助治疗的选择。
