Akinoso-Imran Abdul Qadr, O'Rorke Michael, Kee Frank, Jordao Haydee, Walls Gerard, Bannon Finian J
Centre for Public Health, Queens University Belfast, Institute of Clinical Sciences, Block B, Grosvenor Road, Belfast BT12 6BA, UK.
College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, United States of America.
J Geriatr Oncol. 2022 May;13(4):398-409. doi: 10.1016/j.jgo.2021.11.004. Epub 2021 Nov 12.
Older patients with cancer often have lower surgery rates and survival than younger patients, but this may reflect surgical contraindications of advanced disease, comorbidities, and frailty - and not necessarily under-treatment.
This review aims to describe variations in surgery rates and observed or net survival among younger (<75) and older (≥75) patients with breast, lung and colorectal cancer, while taking account of pre-existing health factors, in order to understand how under-treatment is defined and estimated in the literature.
MEDLINE, EMBASE, Web of Science and PubMed databases were searched for studies reporting surgery rates and observed or net survival among younger and older patients with breast, lung, and colorectal cancer. Study quality was assessed using the Newcastle Ottawa Scale, and random effects meta-analyses were used to combine study results. The I-squared statistic and subgroup analyses were used to assess heterogeneity.
Thirty relatively high-quality studies of patients with breast (230,200; 71.9%), lung (77,573; 24.2%), and colorectal (12,407; 3.9%) cancers were identified. Compared to younger patients, older patients were less likely to receive surgical treatment for 1) breast cancer after adjusting for comorbidity, performance status (PS), functional status and patient choice, 2) lung cancer after accounting for stage, comorbidity, PS, and 3) colorectal cancer after adjusting for stage, comorbidity, and gender. The pooled unadjusted analyses showed lower surgery receipt in older patients with breast (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.13-0.78), lung (OR 0.54, 95% CI 0.39-0.75), and colorectal (OR 0.59, 95% CI 0.51-0.68) cancer. In separate analyses, older patients with breast, lung and colorectal cancer had lower observed and net survival, compared to younger patients.
Lower surgery rates in older patients may contribute to their poorer survival compared to younger patients. Future research quantifying under-treatment should include necessary clinical factors, patient choice, patient's quality of life and a statistically-robust approach, which will demonstrate how much of the survival deficit in older patients is due to their receiving lower surgery rates.
老年癌症患者的手术率和生存率通常低于年轻患者，但这可能反映了晚期疾病、合并症和身体虚弱等手术禁忌证，而不一定是治疗不足。
本综述旨在描述年龄较轻（<75岁）和年龄较大（≥75岁）的乳腺癌、肺癌和结直肠癌患者的手术率差异以及观察到的或净生存率差异，同时考虑到已存在的健康因素，以便了解文献中如何定义和评估治疗不足。
检索MEDLINE、EMBASE、Web of Science和PubMed数据库，查找报告年龄较轻和年龄较大的乳腺癌、肺癌和结直肠癌患者手术率以及观察到的或净生存率的研究。使用纽卡斯尔渥太华量表评估研究质量，并采用随机效应荟萃分析合并研究结果。使用I²统计量和亚组分析评估异质性。
确定了30项质量相对较高的研究，涉及乳腺癌患者（230,200例；71.9%）、肺癌患者（77,573例；24.2%）和结直肠癌患者（12,407例；3.9%）。与年轻患者相比，老年患者接受手术治疗的可能性较小，具体如下：1）调整合并症、体能状态（PS）、功能状态和患者选择后，老年乳腺癌患者；2）考虑分期、合并症、PS后，老年肺癌患者；3）调整分期、合并症和性别后，老年结直肠癌患者。汇总的未调整分析显示，老年乳腺癌患者（比值比[OR]0.31，95%置信区间[CI]0.13 - 0.78）、肺癌患者（OR 0.54，95%CI 0.39 - 0.75）和结直肠癌患者（OR 0.59，95%CI 0.51 - 0.68）接受手术的比例较低。在单独分析中，与年轻患者相比，老年乳腺癌、肺癌和结直肠癌患者的观察到的生存率和净生存率较低。
与年轻患者相比，老年患者手术率较低可能导致其生存率较差。未来量化治疗不足的研究应纳入必要的临床因素、患者选择、患者生活质量以及统计稳健的方法，这将证明老年患者生存率不足中有多少是由于他们接受的手术率较低所致。
