Kellokumpu Ilmo, Kairaluoma Matti, Mecklin Jukka-Pekka, Kellokumpu Henrik, Väyrynen Ville, Wirta Erkki-Ville, Sihvo Eero, Kuopio Teijo, Seppälä Toni T
Department of Gastrointestinal Surgery, Central Finland Hospital Nova, 40620 Jyväskylä, Finland.
Faculty of Sports and Health Sciences, University of Jyväskylä, 40014 Jyväskylä, Finland.
J Clin Med. 2021 Apr 17;10(8):1751. doi: 10.3390/jcm10081751.
This retrospective population-based study examined the impact of age and comorbidity burden on multimodal management and survival from colorectal cancer (CRC). From 2000 to 2015, 1479 consecutive patients, who underwent surgical resection for CRC, were reviewed for age-adjusted Charlson comorbidity index (ACCI) including 19 well-defined weighted comorbidities. The impact of ACCI on multimodal management and survival was compared between low (score 0-2), intermediate (score 3) and high ACCI (score ≥ 4) groups. Changes in treatment from 2000 to 2015 were seen next to a major increase of laparoscopic surgery, increased use of adjuvant chemotherapy and an intensified treatment of metastatic disease. Patients with a high ACCI score were, by definition, older and had higher comorbidity. Major elective and emergency resections for colon carcinoma were evenly performed between the ACCI groups, as were laparoscopic and open resections. (Chemo)radiotherapy for rectal carcinoma was less frequently used, and a higher rate of local excisions, and consequently lower rate of major elective resections, was performed in the high ACCI group. Adjuvant chemotherapy and metastasectomy were less frequently used in the ACCI high group. Overall and cancer-specific survival from stage I-III CRC remained stable over time, but survival from stage IV improved. However, the 5-year overall survival from stage I-IV colon and rectal carcinoma was worse in the high ACCI group compared to the low ACCI group. Five-year cancer-specific and disease-free survival rates did not differ significantly by the ACCI. Cox proportional hazard analysis showed that high ACCI was an independent predictor of poor overall survival ( < 0.001). Our results show that despite improvements in multimodal management over time, old age and high comorbidity burden affect the use of adjuvant chemotherapy, preoperative (chemo)radiotherapy and management of metastatic disease, and worsen overall survival from CRC.
这项基于人群的回顾性研究探讨了年龄和合并症负担对结直肠癌（CRC）多模式治疗及生存的影响。2000年至2015年期间，对1479例连续接受CRC手术切除的患者进行了回顾性分析，计算年龄校正的Charlson合并症指数（ACCI），该指数包含19种明确加权的合并症。比较了低ACCI组（评分0 - 2）、中ACCI组（评分3）和高ACCI组（评分≥4）中ACCI对多模式治疗和生存的影响。2000年至2015年期间，除了腹腔镜手术大幅增加、辅助化疗使用增多以及转移性疾病治疗强化外，治疗也有变化。高ACCI评分的患者，按定义年龄更大且合并症更多。ACCI组之间结肠癌的主要择期和急诊切除手术、腹腔镜和开放切除手术的比例相近。直肠癌的（化疗）放疗使用较少，高ACCI组局部切除率较高，因此主要择期切除率较低。高ACCI组辅助化疗和转移灶切除术的使用较少。I - III期CRC的总生存率和癌症特异性生存率随时间保持稳定，但IV期的生存率有所提高。然而，与低ACCI组相比，高ACCI组I - IV期结肠癌和直肠癌的5年总生存率更差。5年癌症特异性生存率和无病生存率在ACCI组间无显著差异。Cox比例风险分析显示，高ACCI是总生存不良的独立预测因素（<0.001）。我们的结果表明，尽管随着时间推移多模式治疗有所改善，但老年和高合并症负担会影响辅助化疗、术前（化疗）放疗的使用以及转移性疾病的治疗，并使CRC的总生存率降低。
