Badic Bogdan, Bouvier Anne-Marie, Bouvier Véronique, Morvan Marie, Jooste Valérie, Alves Arnaud, Nousbaum Jean-Baptiste, Reboux Noémi
Digestive Surgery Department, CHRU Brest, 29200 Brest, France.
Registre des Cancers Digestifs du Finistère, 29609 Brest, France.
Cancers (Basel). 2022 Oct 24;14(21):5208. doi: 10.3390/cancers14215208.
Oncological strategies in the elderly population are debated. The objective of this study was to determine the predictive factors of survival in patients aged 80 years and older with metastatic colon cancer. Data from four digestive tumour registry databases were used in this analysis. This population-based retrospective study included 1115 patients aged 80 years and older with stage IV colon adenocarcinoma diagnosed between 2007 and 2016. Cox regression was used to assess the impact of different prognostic factors. Age was significantly correlated with the surgical treatment (p < 0.001) but not with overall survival. Patients with a low comorbidity burden had better survival than patients with higher comorbidities scores (9.4 (0−123) versus 7.9 (0−115) months) (p = 0.03). Surgery was more common for proximal colon cancer (p < 0.001), but the location of the primary lesion was not correlated with improved survival (p = 0.07). Patients with lung metastases had a better prognosis than those with liver metastases (HR 0.56 95% CI 0.40, 0.77 p < 0.001); multiple organ involvement had the worst survival (HR 1.32 95% CI 1.15, 1.51 p < 0.001). Chemotherapy was associated with improved survival for both operated (HR 0.45 95% CI 0.35, 0.58 p < 0.001) and non-operated patients (HR 0.41 95% CI 0.34, 0.50 p < 0.001). The majority of patients receiving adjuvant treatment had a low comorbidity burden. In our study, the location of metastases but not the primary tumor location had an impact on overall survival. Low comorbidity burden, curative surgery, and chemotherapy had a significant advantage for elderly patients with metastatic colon cancer.
老年人群的肿瘤治疗策略存在争议。本研究的目的是确定80岁及以上转移性结肠癌患者生存的预测因素。本分析使用了四个消化道肿瘤登记数据库的数据。这项基于人群的回顾性研究纳入了1115例80岁及以上、在2007年至2016年期间被诊断为IV期结肠腺癌的患者。采用Cox回归评估不同预后因素的影响。年龄与手术治疗显著相关（p<0.001），但与总生存期无关。合并症负担低的患者比合并症评分高的患者生存期更长（9.4（0 - 123）个月对7.9（0 - 115）个月）（p = 0.03）。近端结肠癌手术更为常见（p<0.001），但原发灶位置与生存期改善无关（p = 0.07）。肺转移患者的预后优于肝转移患者（HR 0.56，95%CI 0.40，0.77，p<0.001）；多器官受累患者的生存期最差（HR 1.32，95%CI 1.15，1.51，p<0.001）。化疗对接受手术的患者（HR 0.45，95%CI 0.35，0.58，p<0.001）和未接受手术的患者（HR 0.41，95%CI 0.34，0.50，p<0.001）的生存期改善均有影响。大多数接受辅助治疗的患者合并症负担较低。在我们的研究中，转移灶位置而非原发肿瘤位置对总生存期有影响。合并症负担低、根治性手术和化疗对老年转移性结肠癌患者具有显著优势。
