a Department of Medicine , Herlev and Gentofte Hospital, Copenhagen University Hospital , Herlev , Denmark.
b Department of Oncology , Herlev and Gentofte Hospital, Copenhagen University Hospital , Herlev , Denmark.
Acta Oncol. 2018 Nov;57(11):1445-1454. doi: 10.1080/0284186X.2018.1531299. Epub 2018 Oct 30.
First-line chemotherapy for metastatic colorectal cancer (mCRC) is effective and feasible in selected older patients. We investigated age-dependent differences in treatment and outcomes in patients with mCRC in clinical practice.
A retrospective study of 654 patients with mCRC referred to first-line chemotherapy in 2008-2014. Patients were divided into two age groups: 50-69 and ≥70 (older patients). Binary outcomes were analyzed by logistic regression. Progression-free survival (PFS) and overall survival (OS) were analyzed by Cox proportional hazards regression, CRC-specific and other-cause mortality with Fine and Gray proportional hazard model for the sub-distribution of a competing risk.
After adjusting for performance status (PS) and comorbidity, older patients were more likely to receive monotherapy (adjusted odds ratio (aOR) = 9.00, 95% confidence interval (CI) 4.52-17.91), lower doses, and no additional targeted therapy (aOR = 1.89, 95% CI 1.28-2.78) than younger patients. Yet, older patients experienced more toxicity and hospitalizations (aOR = 1.53, 95% CI 1.08-2.17). Among those treated, older patients had shorter PFS (hazard ratio (HR) = 1.32, 95% CI 1.11-1.57), but after adjusting for PS and comorbidity, PFS was similar. No significant difference was found in CRC mortality (HR = 1.15, 95% CI 0.95-1.40) between age groups. Poor PS was associated with shorter OS and PFS and higher CRC mortality.
In the DISCO study, older patients with mCRC received less aggressive first-line chemotherapy. Yet, they experienced more toxicity. Younger and older patients had similar CRC mortality. Shorter PFS and higher CRC mortality were observed in patients with poor PS.
转移性结直肠癌（mCRC）的一线化疗在选定的老年患者中是有效且可行的。我们在临床实践中调查了 mCRC 患者年龄依赖性的治疗和结局差异。
回顾性研究了 2008 年至 2014 年间接受一线化疗的 654 例 mCRC 患者。患者分为两个年龄组：50-69 岁和≥70 岁（老年患者）。采用逻辑回归分析二项结局。采用 Cox 比例风险回归分析无进展生存期（PFS）和总生存期（OS），采用 Fine 和 Gray 比例风险模型分析亚分布竞争风险的 CRC 特异性和其他原因死亡率。
调整体能状态（PS）和合并症后，老年患者更有可能接受单药治疗（调整优势比（aOR）=9.00，95%置信区间（CI）4.52-17.91）、较低剂量和无额外靶向治疗（aOR=1.89，95%CI 1.28-2.78）。然而，老年患者的毒性和住院治疗更多（aOR=1.53，95%CI 1.08-2.17）。在接受治疗的患者中，老年患者的 PFS 更短（风险比（HR）=1.32，95%CI 1.11-1.57），但在调整 PS 和合并症后，PFS 相似。两组之间 CRC 死亡率无显著差异（HR=1.15，95%CI 0.95-1.40）。较差的 PS 与较短的 OS 和 PFS 以及更高的 CRC 死亡率相关。
在 DISCO 研究中，mCRC 的老年患者接受了不那么积极的一线化疗。然而，他们经历了更多的毒性。年轻和老年患者的 CRC 死亡率相似。PS 较差的患者 PFS 更短，CRC 死亡率更高。
