Hamburg University of Applied Sciences, 21033, Hamburg, Germany.
Global Epidemiology Department, Merck KGaA, Frankfurter Str. 250, 64293, Darmstadt, Germany.
J Cancer Res Clin Oncol. 2019 Aug;145(8):2105-2114. doi: 10.1007/s00432-019-02948-6. Epub 2019 Jun 14.
Most metastatic colorectal cancer (mCRC) patients are elderly. This systematic review identifies and describes observational studies evaluating the influence of age on first-line treatment effectiveness in real-world practice.
Medline and EMBASE were searched up to May 2016. The included studies were those that investigated first-line treatment of mCRC and reported age groups and overall survival (OS), progression-free survival (PFS) or overall response rate (ORR) were included. Studies published before 2008 were excluded. Study quality was assessed using the Newcastle-Ottawa Scale. Data were evaluated by age group (< 70 vs. ≥ 70 years; 65-75 vs. ≥ 75 years) and outcome. A pooled survival median was calculated for patients (cutoff = 70 years).
In total, 11 articles with 11,063 patients were included. Four studies using a cutoff of 70 years of age reported OS and PFS, and two studies reported ORRs. In terms of OS, all studies showed a higher OS for those < 70 years of age than for those ≥ 70 years of age. PFS did not find differences by age. For ORRs, one study favoured the younger group, while the second study did not differ by age. Based on three studies, the pooled medians for < 70 years of age and ≥ 70 years of age were the same for PFS (10.2) and were 27.0 and 22.9 for OS, respectively. All included studies were of high or acceptable quality.
The results suggest that age has no effect on PFS. For ORR, the results were inconsistent between studies. Younger patients in general had better OS, which might be partly explained by more aggressive treatment. This treatment seemed not to be guided by performance status or number of metastatic sites.
大多数转移性结直肠癌（mCRC）患者为老年人。本系统评价旨在识别并描述观察性研究，评估在真实世界实践中年龄对一线治疗效果的影响。
检索 Medline 和 EMBASE 数据库，检索时间截至 2016 年 5 月。纳入研究为调查 mCRC 一线治疗且报告年龄组和总生存（OS）、无进展生存（PFS）或总缓解率（ORR）的研究。排除发表于 2008 年之前的研究。使用纽卡斯尔-渥太华量表评估研究质量。根据年龄组（<70 岁与≥70 岁；65-75 岁与≥75 岁）和结局评估数据。对患者（截止值=70 岁）的生存中位数进行汇总。
共纳入 11 项研究，共计 11063 例患者。4 项使用 70 岁作为截止值的研究报告了 OS 和 PFS，2 项研究报告了 ORR。OS 方面，<70 岁患者的 OS 均长于≥70 岁患者。年龄与 PFS 无关。ORR 方面，1 项研究中年轻患者获益更高，而另一项研究则无年龄差异。基于 3 项研究，<70 岁患者和≥70 岁患者的 PFS 汇总中位数相同（10.2），OS 分别为 27.0 和 22.9。纳入的所有研究均为高质量或可接受质量。
结果提示年龄对 PFS 无影响。ORR 方面，研究结果不一致。年轻患者的 OS 总体较好，这可能部分归因于更积极的治疗。该治疗似乎不受体能状态或转移灶数量的影响。
