Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China.
Center for Gut Microbiome Research, Med-X Institute, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Sci Rep. 2023 Sep 8;13(1):14866. doi: 10.1038/s41598-023-41713-1.
Treatment guidelines for colorectal cancer (CRC) in elderly patients remain unclear. This study aimed to investigate whether elderly patients (≥ 70 years) with CRC benefit from surgery and adjuvant therapy. A total of 90,347 eligible CRC patients older than 70 years were collected from the Surveillance, Epidemiology, and End Results (SEER) database and divided into a surgery group and a no-surgery group. After being matched by propensity score matching at a 1:1 ratio, 23,930 patients were included in our analysis. The Kaplan‒Meier method and log-rank test were applied to compare overall survival (OS) and cancer-specific survival (CSS). Univariate and multivariate Cox regression analyses were utilized to confirm independent prognostic factors for OS and CSS. In age-stratified analysis (70-74; 75-79; 80-84; ≥ 85), the OS and CSS rates of patients in the surgery group were significantly higher than those of patients in the no-surgery group (all P < 0.001). Adjuvant therapy was an independent prognostic factor for OS and CSS in elderly patients with CRC (all P < 0.001). Further analysis showed that elderly colon cancer patients with stage III and stage IV disease gained a survival benefit from adjuvant chemotherapy. Adjuvant chemoradiotherapy can significantly improve OS and CSS in elderly rectal cancer patients with stage II, III, and IV disease. In conclusion, among CRC patients aged ≥ 70 years reported in the SEER database, treatment with surgical resection is significantly associated with improved OS and CSS. Moreover, adjuvant therapy led to a significant prognostic advantage for elderly advanced CRC patients who underwent surgery.
老年结直肠癌（CRC）的治疗指南仍不明确。本研究旨在探讨≥70 岁的老年 CRC 患者是否从手术和辅助治疗中获益。从监测、流行病学和最终结果（SEER）数据库中收集了 90347 名符合条件的 70 岁以上 CRC 患者，将其分为手术组和非手术组。通过倾向评分匹配（1:1 比例）进行匹配后，共有 23930 名患者纳入本分析。应用 Kaplan-Meier 方法和对数秩检验比较总生存（OS）和癌症特异性生存（CSS）。采用单因素和多因素 Cox 回归分析确认 OS 和 CSS 的独立预后因素。在年龄分层分析（70-74；75-79；80-84；≥85）中，手术组患者的 OS 和 CSS 率明显高于非手术组患者（均 P<0.001）。辅助治疗是老年 CRC 患者 OS 和 CSS 的独立预后因素（均 P<0.001）。进一步分析显示，III 期和 IV 期老年结肠癌患者接受辅助化疗可获益于生存。辅助放化疗可显著提高 II、III 和 IV 期老年直肠癌患者的 OS 和 CSS。总之，在 SEER 数据库报告的≥70 岁 CRC 患者中，手术切除治疗与 OS 和 CSS 的改善显著相关。此外，辅助治疗为接受手术的老年晚期 CRC 患者带来了显著的预后优势。
