Biodonostia Health Research Institute - Donostia University Hospital / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Paseo Dr. Beguiristain s/n, 20014, Donostia-San Sebastián, Gipuzkoa, Spain.
Research Unit, Hospital Basurto / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Avda Montevideo, 18, 48013, Bilbao, Bizkaia, Spain.
BMC Cancer. 2019 Jul 25;19(1):735. doi: 10.1186/s12885-019-5910-z.
Many older patients don't receive appropriate oncological treatment. Our aim was to analyse whether there are age differences in the use of adjuvant chemotherapy and preoperative radiotherapy in patients with colorectal cancer.
A prospective cohort study was conducted in 22 hospitals including 1157 patients with stage III colon or stage II/III rectal cancer who underwent surgery. Primary outcomes were the use of adjuvant chemotherapy for stage III colon cancer and preoperative radiotherapy for stage II/III rectal cancer. Generalised estimating equations were used to adjust for education, living arrangements, area deprivation, comorbidity and clinical tumour characteristics.
In colon cancer 92% of patients aged under 65 years, 77% of those aged 65 to 80 years and 27% of those aged over 80 years received adjuvant chemotherapy (χ < 0.001). In rectal cancer preoperative radiotherapy was used in 68% of patients aged under 65 years, 60% of those aged 65 to 80 years, and 42% of those aged over 80 years (χ < 0.001). Adjusting by comorbidity level, tumour characteristics and socioeconomic level, the odds ratio of use of chemotherapy compared with those under age 65, was 0.3 (0.1-0.6) and 0.04 (0.02-0.09) for those aged 65 to 80 and those aged over 80, respectively; similarly, the odds ratio of use of preoperative radiotherapy was 0.9 (0.6-1.4) and 0.5 (0.3-0.8) compared with those under 65 years of age.
The probability of older patients with colorectal cancer receiving adjuvant chemotherapy and preoperative radiotherapy is lower than that of younger patients; many of them are not receiving the treatments recommended by clinical practice guidelines. Differences in comorbidity, tumour characteristics, curative resection, and socioeconomic factors do not explain this lower probability of treatment. Research is needed to identify the role of physical and cognitive functional status, doctors' attitudes, and preferences of patients and their relatives, in the use of adjuvant therapies.
许多老年患者未接受适当的肿瘤治疗。我们的目的是分析结直肠癌患者接受辅助化疗和术前放疗的情况是否存在年龄差异。
在 22 家医院进行了一项前瞻性队列研究，共纳入 1157 例 III 期结肠癌或 II/III 期直肠癌患者，均接受手术治疗。主要结局是 III 期结肠癌患者接受辅助化疗和 II/III 期直肠癌患者接受术前放疗的情况。采用广义估计方程调整教育程度、居住安排、地区贫困程度、合并症和临床肿瘤特征的影响。
在结肠癌患者中，年龄＜65 岁、65-80 岁和＞80 岁的患者分别有 92%、77%和 27%接受辅助化疗（χ²＜0.001）。在直肠癌患者中，年龄＜65 岁、65-80 岁和＞80 岁的患者分别有 68%、60%和 42%接受术前放疗（χ²＜0.001）。在调整合并症严重程度、肿瘤特征和社会经济水平后，与＜65 岁患者相比，65-80 岁和＞80 岁患者接受化疗的比值比分别为 0.3（0.1-0.6）和 0.04（0.02-0.09）；同样，与＜65 岁患者相比，接受术前放疗的比值比分别为 0.9（0.6-1.4）和 0.5（0.3-0.8）。
老年结直肠癌患者接受辅助化疗和术前放疗的概率低于年轻患者；许多患者未接受临床实践指南推荐的治疗。合并症、肿瘤特征、根治性切除和社会经济因素的差异并不能解释这种治疗概率降低的原因。需要研究身体和认知功能状态、医生态度以及患者及其家属的偏好在辅助治疗中的作用。
