Zhao Zhuoyang, Lin Jinxin, Chen Shunlun, Wang Xiaolin, Wang Heng, Xu Gaopo, Wang Jianru, Zhou Ruwen, Huang Zenghong, Li Yingjie, Zhang Yu, Liu Xiaoxia, Wang Puning, Huang Meijin, Luo Yanxin, Yu Huichuan
Department of Spine Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.
Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China.
Heliyon. 2023 May 5;9(5):e15966. doi: 10.1016/j.heliyon.2023.e15966. eCollection 2023 May.
Aging confers an increased risk of developing cancer, and the global burden of cancer is cumulating as human longevity increases. Providing adequate care for old patients with rectal cancer is challenging and complex.
A total of 428 and 44,788 patients diagnosed with non-metastatic rectal cancer from a referral tertiary care center (SYSU cohort) and the Surveillance Epidemiology and End Results database (SEER cohort) were included. Patients were categorized into old (over 65 years) and young (aged 50-65 years) groups. An age-specific clinical atlas of rectal cancer was generated, including the demographic and clinicopathological features, molecular profiles, treatment strategies, and clinical outcomes.
Old and young patients were similar in clinicopathological risk factors and molecular features, including TNM stage, tumor location, tumor differentiation, tumor morphology, lymphovascular invasion, and perineural invasion. However, old patients had significantly worse nutritional status and more comorbidities than young patients. In addition, old age was independently associated with less systemic cancer treatment (adjusted odds ratio 0.294 [95% CI 0.184-0.463, P < 0.001]). We found that old patients had significantly worse overall survival (OS) outcomes in both SYSU (P < 0.001) and SEER (P < 0.001) cohorts. Moreover, the death and recurrence risk of old patients in the subgroup not receiving chemo/radiotherapy (P < 0.001 for OS, and P = 0.046 for time to recurrence [TTR]) reverted into no significant risk in the subgroup receiving chemo/radiotherapy.
Although old patients had similar tumor features to young patients, they had unfavorable survival outcomes associated with insufficient cancer care from old age. Specific trials with comprehensive geriatric assessment for old patients are needed to identify the optimal treatment regimens and improve unmet cancer care.
The study was registered on the research registry with the identifier of researchregistry 7635.
衰老会增加患癌风险，且随着人类寿命延长，全球癌症负担正在累积。为老年直肠癌患者提供充分护理具有挑战性且复杂。
纳入了来自一家转诊三级护理中心（中山大学队列）的428例和监测、流行病学与最终结果数据库（SEER队列）的44788例诊断为非转移性直肠癌的患者。患者被分为老年组（65岁以上）和青年组（50 - 65岁）。生成了一份特定年龄的直肠癌临床图谱，包括人口统计学和临床病理特征、分子特征、治疗策略及临床结局。
老年和青年患者在临床病理危险因素和分子特征方面相似，包括TNM分期、肿瘤位置、肿瘤分化、肿瘤形态、淋巴管侵犯和神经周围侵犯。然而，老年患者的营养状况明显比青年患者差，且合并症更多。此外，高龄独立与较少的全身性癌症治疗相关（调整后的优势比为0.294 [95%置信区间0.184 - 0.463，P < 0.001]）。我们发现，在中山大学队列（P < 0.001）和SEER队列（P < 0.001）中，老年患者的总生存（OS）结局均明显更差。此外，未接受化疗/放疗亚组中老年患者的死亡和复发风险（OS的P < 0.001，复发时间[TTR]的P = 0.046）在接受化疗/放疗亚组中转变为无显著风险。
尽管老年患者的肿瘤特征与青年患者相似，但他们的生存结局不佳，与老年时癌症护理不足有关。需要针对老年患者进行综合老年评估的特定试验，以确定最佳治疗方案并改善未满足的癌症护理。
该研究在研究注册平台上注册，标识符为researchregistry 7635。
