Shiraishi Takuya, Ogawa Hiroomi, Shioi Ikuma, Ozawa Naoya, Osone Katsuya, Okada Takuhisa, Sohda Makoto, Shirabe Ken, Saeki Hiroshi
Department of General Surgical Science Gunma University Graduate School of Medicine Maebashi Japan.
Ann Gastroenterol Surg. 2022 Aug 26;7(1):91-101. doi: 10.1002/ags3.12604. eCollection 2023 Jan.
We aimed to clarify the use of adjuvant chemotherapy and the prognosis of elderly colorectal cancer patients compared with non-elderly patients, and the usefulness of sarcopenia as an indicator for the introduction and completion of adjuvant chemotherapy.
Between 2013 and 2021, 215 patients with pStage III disease were included. We investigated perioperative clinicopathological factors, adjuvant chemotherapy details, and prognosis. Preoperative sarcopenia status was evaluated using computed tomography images. Elderly patients were defined as those aged ≥70 years.
We included 121 (56.3%) and 94 (43.7%) non-elderly and elderly patients, respectively. Among the elderly patients, 47 had sarcopenia. There were no significant differences in the incompletion rate of adjuvant chemotherapy between elderly and non-elderly patients (27.1%/16.2%, = 0.119). The most common reason for the discontinuation of adjuvant chemotherapy was side effects, regardless of age. The respective 3-year-disease free survival of patients with no/completed/incomplete adjuvant chemotherapy were 65.5%, 80.2%, and 57.7% for non-elderly patients ( = 0.045) and 73.4%, 70.6%, and 71.6% for elderly patients ( = 0.924). The number of elderly patients with sarcopenia was significantly higher in patients without adjuvant chemotherapy ( = 0.004) and those with incomplete adjuvant chemotherapy ( = 0.004). The 3-year-disease free survival of elderly sarcopenic patients without and with adjuvant chemotherapy were 78.3% and 59.2%, respectively ( = 0.833).
Elderly patients did not show a benefit of adjuvant chemotherapy regardless of whether they had completed adjuvant chemotherapy, unlike non-elderly patients. Moreover, the evaluation of preoperative sarcopenia in elderly colorectal cancer patients may be useful in determining the indication for adjuvant chemotherapy.
我们旨在阐明与非老年患者相比，老年结直肠癌患者辅助化疗的使用情况及预后，以及肌肉减少症作为辅助化疗开始和完成指标的有用性。
纳入2013年至2021年间215例pIII期疾病患者。我们调查了围手术期临床病理因素、辅助化疗细节及预后。使用计算机断层扫描图像评估术前肌肉减少症状态。老年患者定义为年龄≥70岁者。
我们分别纳入了121例（56.3%）非老年患者和94例（43.7%）老年患者。在老年患者中，47例有肌肉减少症。老年和非老年患者辅助化疗未完成率无显著差异（27.1%/16.2%，P = 0.119）。无论年龄大小，辅助化疗中断的最常见原因是副作用。非老年患者未进行/完成/未完成辅助化疗的3年无病生存率分别为65.5%、80.2%和57.7%（P = 0.045），老年患者分别为73.4%、70.6%和71.6%（P = 0.924）。未进行辅助化疗（P = 0.004）和辅助化疗未完成（P = 0.004）的患者中，有肌肉减少症的老年患者数量显著更高。未进行和进行辅助化疗的老年肌肉减少症患者的3年无病生存率分别为78.3%和59.2%（P = 0.833）。
与非老年患者不同，老年患者无论是否完成辅助化疗均未显示出辅助化疗的益处。此外，评估老年结直肠癌患者术前肌肉减少症可能有助于确定辅助化疗的适应证。
