Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, 1, Hikarigaoka, Fukushima, Japan.
Department of Surgery, Southern Tohoku General Hospital, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Kooriyama, Fukushima, Japan.
Int J Clin Oncol. 2021 Jul;26(7):1248-1256. doi: 10.1007/s10147-021-01909-9. Epub 2021 Jun 5.
It remains unclear whether intensive chemotherapy for Stage IV colorectal cancer (CRC) patients aged 80 years or older is beneficial prognostically. This study aimed to investigate the overall survival of Stage IV CRC patients aged ≥ 80 years receiving intensive chemotherapy.
The study design was a population-based, multicenter, historical cohort study. The extracted participants' data were consecutive patients diagnosed as Stage IV CRC between January 2008 and May 2015 in nine hospitals in Japan. Patients were classified into two groups according to age: aged group (≥ 80 years) and younger group (< 80 years old). Intensive chemotherapy was defined as at least two courses of doublet chemotherapy with oxaliplatin-or irinotecan-based regimens. The primary outcome was the adjusted hazard ratio (HR) of age ≥ 80 years in patients who undergoing intensive chemotherapy.
During the study period, 1259 patients were treated for Stage IV CRC in the participating hospitals. In total, 231 patients (18.3%) were in the aged group, and 1028 (81.7%) were in the younger group, and 788 (62.6%) underwent intensive chemotherapy. The median overall survival for the aged and younger group patients was 21.0 months (interquartile range (IQR), 10.6-34.1 months) and 24.3 months (IQR 12.6-39.3 months), respectively. The adjusted HR of age ≥ 80 years was 1.29 (confidence intervals 0.84-2.00).
Stage IV CRC patients aged 80 years or older receiving intensive chemotherapy had a similar prognosis to those aged < 80 years. Avoiding intensive chemotherapy for mCRC patients simply because they are ≥ 80 years old is not recommended.
目前尚不清楚对于 80 岁或以上的 IV 期结直肠癌（CRC）患者进行强化化疗是否具有预后获益。本研究旨在调查接受强化化疗的 80 岁及以上 IV 期 CRC 患者的总生存情况。
本研究为基于人群的多中心历史队列研究。提取了 2008 年 1 月至 2015 年 5 月期间在日本 9 家医院诊断为 IV 期 CRC 的连续患者的数据。患者根据年龄分为两组：年龄组（≥80 岁）和年轻组（<80 岁）。强化化疗定义为至少进行 2 个疗程的奥沙利铂或伊立替康为基础的双联化疗方案。主要结局指标为年龄≥80 岁的患者接受强化化疗的调整后的危险比（HR）。
在研究期间，参与医院共收治 1259 例 IV 期 CRC 患者。共有 231 例（18.3%）患者为年龄组，1028 例（81.7%）为年轻组，788 例（62.6%）接受强化化疗。年龄组和年轻组患者的中位总生存时间分别为 21.0 个月（四分位距（IQR），10.6-34.1 个月）和 24.3 个月（IQR，12.6-39.3 个月）。年龄≥80 岁的调整 HR 为 1.29（置信区间 0.84-2.00）。
接受强化化疗的 80 岁或以上的 IV 期 CRC 患者的预后与年龄<80 岁的患者相似。不建议仅仅因为患者≥80 岁就避免对 mCRC 患者进行强化化疗。
