CHRU Brest, Service de Chirurgie Viscérale, Brest, France.
INSERM, UMR 1101, LaTIM, 22 rue Camille Desmoulins, 29238, Brest, France.
Int J Colorectal Dis. 2021 Apr;36(4):811-819. doi: 10.1007/s00384-021-03861-6. Epub 2021 Feb 2.
Oncological strategies in the elderly population are debated. The objective of this study was to assess the factors predictive of poor prognosis in elderly patients with stage III colon cancer.
A retrospective review of demographic, pathologic, treatment, and outcome data from 308 patients with stage III colon adenocarcinoma who had undergone surgery between 2007 and 2014 was conducted. A proportional hazards model was used to assess the association of prognostic factors with disease-free survival (DFS) and overall survival (OS).
The 5-year survival rate was 34.4% (95% CI 27.1-39.8%) and Charlson comorbidity index was a significant predictor of death (p < 0.01). The presence of perineural invasion (p = 0.03) and incomplete resection (p < 0.001) were significantly correlated with OS. The postoperative (30 days) mortality rate was 11.7%. Adjuvant chemotherapy was significantly associated with better OS (p < 0.001) independently of the regimens. Disease-free survival was significantly correlated with adjuvant chemotherapy (HR 0.63, 95% CI: 0.42-0.97, p = 0.034), Charlson comorbidity index (CCI 5; HR 1.61, 95% CI: 1.05-2.48, p = 0.029), and venous and/or perineural invasion (HR 1.54, 95% CI: 1.03-2.29, p = 0.035).
Age, comorbidities, tumor histology, and adjuvant chemotherapy were independent predictors of prognosis in patients with stage III colon cancer. These data can be used to identify elderly patients with poor prognosis and to design future tailored randomized clinical trials.
ClinicalTrial.gov No. NCT04526314. Date of registration 25 August 2020.
老年人群的肿瘤治疗策略存在争议。本研究旨在评估影响 III 期结肠癌老年患者预后的因素。
回顾性分析 2007 年至 2014 年间 308 例接受手术治疗的 III 期结肠腺癌患者的人口统计学、病理、治疗和结局数据。采用比例风险模型评估预后因素与无病生存（DFS）和总生存（OS）的相关性。
5 年生存率为 34.4%（95%CI 27.1-39.8%），Charlson 合并症指数是死亡的显著预测因素（p<0.01）。存在神经周围侵犯（p=0.03）和不完全切除（p<0.001）与 OS 显著相关。术后（30 天）死亡率为 11.7%。辅助化疗与 OS 显著相关（p<0.001），与方案无关。DFS 与辅助化疗显著相关（HR 0.63，95%CI：0.42-0.97，p=0.034）、Charlson 合并症指数（CCI5；HR 1.61，95%CI：1.05-2.48，p=0.029）和静脉及/或神经周围侵犯（HR 1.54，95%CI：1.03-2.29，p=0.035）。
年龄、合并症、肿瘤组织学和辅助化疗是 III 期结肠癌患者预后的独立预测因素。这些数据可用于识别预后不良的老年患者，并设计未来的个体化随机临床试验。
ClinicalTrials.gov 编号 NCT04526314。注册日期 2020 年 8 月 25 日。
