University of South Australia Allied Health and Human Performance, Adelaide, SA, Australia.
University of South Australia, Cancer Epidemiology and Population Health, Adelaide, SA, Australia.
Front Public Health. 2023 Apr 6;11:1101771. doi: 10.3389/fpubh.2023.1101771. eCollection 2023.
Although survival from colorectal cancer (CRC) has improved substantially in recent decades, people with advanced age still have a high likelihood of mortality from this disease. Nonetheless, few studies have investigated how cancer stage, subsite and comorbidities contribute collectively to poor prognosis of older people with CRC. Here, we decided to explore the association of age with mortality measures and how other variables influenced this association.
Using linkage of several administrative datasets, we investigated the risk of death among CRC cases during 2003-2014. Different models were used to explore the association of age with mortality measures and how other variables influenced this association.
Our results indicated that people diagnosed at a young age and with lower comorbidity had a lower likelihood of all-cause and CRC-specific mortality. Aging had a greater association with mortality in early-stage CRC, and in rectal cancer, compared that seen with advanced-stage CRC and right colon cancer, respectively. Meanwhile, people with different levels of comorbidity were not significantly different in terms of their increased likelihood of mortality with advanced age. We also found that while most comorbidities were associated with all-cause mortality, only dementia [SHR = 1.43 (1.24-1.64)], Peptic ulcer disease [SHR = 1.12 (1.02-1.24)], kidney disease [SHR = 1.11 (1.04-1.20)] and liver disease [SHR = 1.65 (1.38-1.98)] were risk factors for CRC-specific mortality.
This study showed that the positive association of advanced age with mortality in CRC depended on stage and subsite of the disease. We also found only a limited number of comorbidities to be associated with CRC-specific mortality. These novel findings implicate the need for more attention on factors that cause poor prognosis in older people.
尽管近年来结直肠癌（CRC）的生存率有了显著提高，但年龄较大的患者死于该病的可能性仍然很高。尽管如此，很少有研究调查癌症分期、部位和合并症如何共同导致 CRC 老年患者预后不良。在这里，我们决定探讨年龄与死亡率之间的关系，以及其他变量如何影响这种关系。
使用多个行政数据集的链接，我们研究了 2003-2014 年期间 CRC 病例的死亡风险。使用不同的模型来探讨年龄与死亡率之间的关系，以及其他变量如何影响这种关系。
我们的研究结果表明，在年轻时诊断出且合并症较少的患者全因死亡率和 CRC 特异性死亡率较低。在早期 CRC 和直肠癌中，年龄与死亡率的相关性大于晚期 CRC 和右半结肠癌。同时，不同合并症水平的患者在年龄较大时死亡率增加方面没有显著差异。我们还发现，虽然大多数合并症与全因死亡率相关，但只有痴呆症 [SHR = 1.43（1.24-1.64）]、消化性溃疡病 [SHR = 1.12（1.02-1.24）]、肾病 [SHR = 1.11（1.04-1.20）]和肝病 [SHR = 1.65（1.38-1.98）]是 CRC 特异性死亡率的危险因素。
这项研究表明，CRC 中年龄与死亡率的正相关取决于疾病的分期和部位。我们还发现只有少数合并症与 CRC 特异性死亡率相关。这些新发现表明，需要更多关注导致老年人预后不良的因素。
