Hoshino Nobuaki, Aoyama Ryuhei, Hida Koya
Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Int J Clin Oncol. 2021 May;26(5):883-892. doi: 10.1007/s10147-021-01858-3. Epub 2021 Jan 9.
Adjuvant chemotherapy after curative resection is established as a standard therapy for colon and rectal cancer. Although the efficacy of adjuvant chemotherapy has been shown by pooled analyses from randomized controlled trials, elderly patients still receive adjuvant chemotherapy less frequently than younger patients. In this systematic review and meta-analysis, we aimed to assess the survival benefit of adjuvant chemotherapy in elderly patients based on observational studies in which the elderly patients would likely be representative of those encountered in real-world clinical settings.
A comprehensive literature search was conducted using PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. Observational studies that investigated the survival benefit of adjuvant chemotherapy after curative resection in elderly patients (age ≥ 70 years) with colon or rectal cancer were included. The 5-year overall survival (OS) rate and OS were assessed. Risk of bias was assessed using the ROBINS-I tool.
Eleven studies in elderly patients with colon cancer were included. No relevant study was identified for rectal cancer. Elderly patients who received adjuvant chemotherapy had a significantly higher 5-year OS rate than those who did not (risk ratio 1.51, 95% confidence interval 1.29-1.76, P < 0.001). There was also a significant improvement in OS in elderly patients who received adjuvant chemotherapy (hazard ratio 0.59, 95% confidence interval 0.53-0.66, P < 0.001). The overall risk of bias was judged to be critical for both outcomes.
Adjuvant chemotherapy provides a survival benefit for elderly patients with colon cancer, although the quality of evidence is low.
根治性切除术后的辅助化疗已成为结肠癌和直肠癌的标准治疗方法。尽管随机对照试验的汇总分析已显示辅助化疗的疗效，但老年患者接受辅助化疗的频率仍低于年轻患者。在这项系统评价和荟萃分析中，我们旨在基于观察性研究评估老年患者辅助化疗的生存获益，在这些研究中，老年患者可能代表现实临床环境中遇到的患者。
使用PubMed、Scopus和Cochrane对照试验中央注册库进行全面的文献检索。纳入调查老年（年龄≥70岁）结肠癌或直肠癌患者根治性切除术后辅助化疗生存获益的观察性研究。评估5年总生存率（OS）和OS。使用ROBINS-I工具评估偏倚风险。
纳入了11项老年结肠癌患者的研究。未发现直肠癌的相关研究。接受辅助化疗的老年患者5年OS率显著高于未接受辅助化疗的患者（风险比1.51，95%置信区间1.29-1.76，P<0.001）。接受辅助化疗的老年患者OS也有显著改善（风险比0.59，95%置信区间0.53-0.66，P<0.001）。两种结果的总体偏倚风险均被判定为严重。
辅助化疗为老年结肠癌患者带来生存获益，尽管证据质量较低。
