Liu Lizhu, Pang Xiaolin, Zhao Ke, Chen Yaxue, Li Yanli, You Ruimin, Xu Tingting, Liu Mengmei, Wu Lin, Li Zhenhui, Pu Hongjiang
Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Centre, Kunming, 650118, People's Republic of China.
Department of Radiotherapy, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, People's Republic of China.
Int J Gen Med. 2023 Aug 3;16:3311-3322. doi: 10.2147/IJGM.S420024. eCollection 2023.
It is common for elderly patients to be underrepresented in clinical trials for cancer, which can result in a lack of efficacy data and unclear criteria to guide treatment decisions for clinical doctors. Therefore, one of the common challenges in oncology treatment is determining the extent to which patients aged 75 and older have benefited from postoperative chemotherapy.
The study aimed to explore the effect of adjuvant chemotherapy (AC) on 3-year recurrence-free survival (RFS) after curative resection in patients aged 75 years and older with stage II-III colorectal cancer (CRC).
The retrospective cohort analysis was performed on patients with stage II-III CRC who received curative resection at three cancer centers in China between 2008 and 2017. Kaplan-Meier curves and Multivariable Cox regression models were used to analyze the impact of AC on RFS in patients. Finally, propensity-score matching was used to reduce selection bias and confounding factors in patients aged 75 years and older with stage II-III CRC.
A total of 2885 patients were included (1729 (59.9%) male; 1312 (61.5%) received AC). The pre-matching cohort was comprised of 151 patients aged 75 years and older (median age (IQR)77.00 (76.00, 79.00); 97 (64.2%) male, 51 (72.9%) received AC). Age (=0.001), postoperative carcinoembryonic antigen (CEA)(=0.02) level were associated with prognosis. But AC was not associated with 3-year RFS (HR, 1.27; 95% CI, 0.80-2.0; log-rank =0.37). After a predisposition 1: 1 match (with or without AC, n = 42), AC remains uncorrelated with 3-year RFS (HR, 1.39; 95% CI, 0.52-3.70; log-rank =0.66).
Patients over the age of 75 with stage II-III CRC who receive AC or do not face the same risk of postoperative recurrence. As a result, patients with stage II-III postoperative adjuvant chemotherapy can make an informed decision regarding whether they want to undergo chemotherapy based on their age and reduce the unnecessary side effects of chemotherapy.
老年患者在癌症临床试验中的代表性不足很常见，这可能导致缺乏疗效数据，且临床医生缺乏指导治疗决策的明确标准。因此，肿瘤治疗中常见的挑战之一是确定75岁及以上患者从术后化疗中获益的程度。
本研究旨在探讨辅助化疗（AC）对75岁及以上II-III期结直肠癌（CRC）患者根治性切除术后3年无复发生存期（RFS）的影响。
对2008年至2017年在中国三个癌症中心接受根治性切除的II-III期CRC患者进行回顾性队列分析。采用Kaplan-Meier曲线和多变量Cox回归模型分析AC对患者RFS的影响。最后，采用倾向评分匹配法减少75岁及以上II-III期CRC患者的选择偏倚和混杂因素。
共纳入2885例患者（1729例（59.9%）为男性；1312例（61.5%）接受AC）。匹配前队列包括151例75岁及以上患者（中位年龄（IQR）77.00（76.00，79.00）；97例（64.2%）为男性，51例（72.9%）接受AC）。年龄（=0.001）、术后癌胚抗原（CEA）水平（=0.02）与预后相关。但AC与3年RFS无关（HR，1.27；95%CI，0.80-2.0；log-rank =0.37）。在进行1:1倾向匹配（有或无AC，n = 42）后，AC仍与3年RFS无关（HR，1.39；95%CI，0.52-3.70；log-rank =0.66）。
75岁及以上II-III期CRC患者接受AC或不接受AC面临的术后复发风险相同。因此，II-III期术后辅助化疗患者可以根据年龄就是否接受化疗做出明智的决定，并减少化疗不必要的副作用。
