80岁以上转移性结直肠癌的临床、治疗特征及预后因素：一项回顾性研究
Clinical and therapeutic features and prognostic factors of metastatic colorectal cancer over age 80: a retrospective study.
作者信息
Hisada Hiroyuki, Takahashi Yu, Kubota Manabu, Shimura Haruhisa, Itobayashi Ei, Shimura Kenji, Nakamura Akira
机构信息
Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Department of Gastroenterology, Asahi General Hospital, Chiba, Japan.
出版信息
BMC Gastroenterol. 2021 May 1;21(1):199. doi: 10.1186/s12876-021-01791-9.
BACKGROUND
Colorectal cancer (CRC) is one of the most common cancers in the world. The number of elderly patients with CRC increases due to aging of the population. There are few studies that examined chemotherapy and prognostic factors in metastatic colorectal cancer (mCRC) patients aged ≥ 80 years. We assessed the efficacy of chemotherapy and prognostic factors among patients with mCRC aged ≥ 80 years.
METHODS
We retrospectively analyzed clinical and laboratory findings of 987 patients newly diagnosed with CRC at Asahi General Hospital (Chiba, Japan) between January 2012 and December 2016. The Kaplan-Meier method was used for the overall survival (OS) and the log-rank test was used to identify difference between patients. A multivariate Cox proportional hazard regression analysis was performed to determine the hazard ratios and 95% confidence intervals (CIs) of prognostic factors among super-elderly patients.
RESULTS
In total, 260 patients were diagnosed with mCRC (super-elderly group: n = 43, aged ≥ 80 years and younger group, n = 217, aged < 80 years). The performance status and nutritional status were worse in the super-elderly group than in the younger group. The OS of super-elderly patients who received chemotherapy was worse than that of younger patients (18.5 vs. 28.8 months; P = 0.052), although the difference was not significant. The OS of patients who received chemotherapy tended to be longer than that of those who did not; however, there were no significant differences in OS in the super-elderly group (18.5 vs. 8.4 months P = 0.33). Multivariate analysis revealed that carcinoembryonic antigen levels ≥ 5 ng/mL (hazard ratio: 2.27; 95% CI 1.09-4.74; P = 0.03) and prognostic nutritional index ≤ 35 (hazard ratio: 8.57; 95% CI 2.63-27.9; P = 0.0003) were independently associated with poor OS in the super-elderly group.
CONCLUSIONS
Patients with mCRC aged ≥ 80 years had lower OS than younger patients even though they received chemotherapy. Carcinoembryonic antigen and prognostic nutritional index were independent prognostic factors in super-elderly patients with mCRC, but chemotherapy was not.
TRIAL REGISTRATION
retrospectively registered.
背景
结直肠癌（CRC）是世界上最常见的癌症之一。由于人口老龄化，老年CRC患者的数量不断增加。很少有研究探讨年龄≥80岁的转移性结直肠癌（mCRC）患者的化疗及预后因素。我们评估了年龄≥80岁的mCRC患者的化疗疗效及预后因素。
方法
我们回顾性分析了2012年1月至2016年12月在日本千叶旭川综合医院新诊断为CRC的987例患者的临床和实验室检查结果。采用Kaplan-Meier法计算总生存期（OS），并使用对数秩检验来确定患者之间的差异。进行多因素Cox比例风险回归分析，以确定超高龄患者预后因素的风险比及95%置信区间（CI）。
结果
共有260例患者被诊断为mCRC（超高龄组：n = 43，年龄≥80岁；年轻组：n = 217，年龄<80岁）。超高龄组的体能状态和营养状况比年轻组差。接受化疗的超高龄患者的OS比年轻患者差（18.5个月对28.8个月；P = 0.052），尽管差异不显著。接受化疗的患者的OS往往比未接受化疗的患者长；然而，超高龄组的OS无显著差异（18.5个月对8.4个月，P = 0.33）。多因素分析显示，癌胚抗原水平≥5 ng/mL（风险比：2.27；95% CI 1.09 - 4.74；P = 0.03）和预后营养指数≤35（风险比：8.57；95% CI 2.63 - 27.9；P = 0.0003）与超高龄组患者较差的OS独立相关。
结论
年龄≥80岁的mCRC患者即使接受了化疗，其OS也低于年轻患者。癌胚抗原和预后营养指数是超高龄mCRC患者的独立预后因素，但化疗不是。
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