Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands.
Department of Medical and Surgical Science - DIMEC, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
World J Surg. 2019 Aug;43(8):2077-2085. doi: 10.1007/s00268-019-04978-0.
An aging population combined with an increased colorectal cancer (CRC) incidence in the older population will increase its prevalence in the elderly, questioning how many years of life are lost (YLLs) in these patients.
Data from 32,568 Dutch CRC patients ≥ 80 years were used to estimate the number of YLLs after diagnosis, using a reference age-, sex- and year-of-onset-matched cohort derived from national life tables. YLLs were additionally adjusted by comorbidities. Number needed to treat (NNT) was used as measure of surgical effect size.
Surgery was applied in 74.9% of patients leading to 1.3 YLLs, being superior in 86.1% of cases with respect to alternative therapies (YLLs 4.8 years) and resulting in a number of two patients needed to operate to achieve one positive outcome. YLLs and NNTs depended on CRC stage, patient' age and comorbidities. For Stage I-II patients in the best clinical conditions (80-85 years without comorbidities), YLLs increased up to 4.1 years after surgery and up to 8.8 years without surgery (NNT 3). For Stage III patients, the NNT of surgery varied between 2 when they were in the best clinical conditions and 4 when they were older with high comorbidities. In Stage IV patients, the NNT ranged between 6 and 31.
YLLs represents a novel approach to evaluate CRC prognosis. Stage I-III surgical patients can have a life expectancy similar to that of general population, being the NNT of surgery reasonably small compared with alternatives. Personalized comorbidity data are needed to confirm present findings.
人口老龄化加上老年人群中结直肠癌（CRC）发病率的增加，将使老年人群中的 CRC 患病率增加，这引发了一个问题，即这些患者有多少年的生命损失（YLLs）。
使用来自 32568 名荷兰≥80 岁 CRC 患者的数据，通过从全国生命表中得出的与年龄、性别和发病年龄相匹配的参考队列，估计诊断后的 YLLs 数量。此外，还通过合并症对 YLLs 进行了调整。采用需要治疗的人数（NNT）作为手术效果大小的衡量标准。
74.9%的患者接受了手术治疗，导致 1.3 年的 YLLs，在 86.1%的情况下优于替代治疗（YLLs 为 4.8 年），需要治疗两个人才能获得一个阳性结果。YLLs 和 NNTs 取决于 CRC 分期、患者年龄和合并症。对于处于最佳临床状况（无合并症，80-85 岁）的 I-II 期患者，手术后 YLLs 增加了 4.1 年，无手术情况下增加了 8.8 年（NNT 为 3）。对于 III 期患者，手术的 NNT 在最佳临床条件下（NNT 为 2）和高龄合并症较高时（NNT 为 4）之间变化。在 IV 期患者中，NNT 范围在 6 至 31 之间。
YLLs 是评估 CRC 预后的一种新方法。I-III 期手术患者的预期寿命可与一般人群相似，与替代疗法相比，手术的 NNT 相对较小。需要个性化的合并症数据来证实目前的发现。
