Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Department of General Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel. Electronic address: https://twitter.com/RachellGefen.
Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Colorectal Surgery Unit, Mansoura University Hospital, Mansoura University, Egypt. Electronic address: https://twitter.com/dr_samehany81.
Surgery. 2023 Dec;174(6):1315-1322. doi: 10.1016/j.surg.2023.08.007. Epub 2023 Sep 19.
Characteristics of colorectal diseases may vary according to the patient's age. By using a large national database, we assessed age-related differences in characteristics and treatments of colorectal cancer and to evaluate the influence of age on outcomes.
Retrospective cohort analysis of all patients who underwent surgical resection for colorectal cancer in the US National Cancer Database between 2005 and 2019. Patients were divided into 3 age groups: young age onset (<50 years), middle age group (50-79 years), and very old (≥80 years). Differences in tumor characteristics among groups were assessed. The main outcomes were clinical and treatment characteristics and short-term mortality.
In total, 662,102 patients with colon cancer and 114,460 with rectal cancer were included-36.1% of young patients with colon cancer presented with metastatic disease. Older patients underwent open surgery more often and received chemotherapy and radiation therapy less often than did the other 2 groups regarding disease stage. Very old patients, compared to middle-aged and young patients, had longer hospitalization and significantly higher rates of 30-day mortality after colon (7.6% vs 2.4% vs 0.7%; P < .001) and rectal (5.9% vs 1.3% vs 0.3%; P < .001) cancer surgery and higher 90-day mortality after colon (12.9% vs 4.6% vs 1.7% P < .001) and rectal (10.3% vs 2.6% vs 0.7%; P < .001) cancer surgery.Older patients had significantly shorter overall survival than the other 2 groups, regardless of pathologic stage, Charlson -Deyo comorbidity score, or tumor side.
Significant age-related disparities in characteristics, treatments, and outcomes of colorectal cancer were found in this study. Recognizing these differences can be the first step toward reducing age-related treatment differences.
结直肠癌的特征可能因患者的年龄而异。本研究使用大型国家数据库评估了结直肠癌特征和治疗方面的年龄相关性差异，并评估了年龄对结局的影响。
本研究回顾性分析了 2005 年至 2019 年期间在美国国家癌症数据库中接受结直肠癌手术的所有患者，根据年龄将患者分为 3 组：年轻发病组（<50 岁）、中年组（50-79 岁）和非常老年组（≥80 岁）。评估组间肿瘤特征的差异。主要结局是临床和治疗特征以及短期死亡率。
共纳入 662102 例结肠癌患者和 114460 例直肠癌患者，年轻结肠癌患者中有 36.1%为转移性疾病。对于疾病分期，与其他 2 组相比，老年患者更常接受开放手术，接受化疗和放疗的比例较低。与中年和年轻患者相比，非常老年患者的住院时间更长，且结肠癌（7.6%比 2.4%比 0.7%；P<0.001）和直肠癌（5.9%比 1.3%比 0.3%；P<0.001）手术后 30 天死亡率显著更高，结肠癌（12.9%比 4.6%比 1.7%；P<0.001）和直肠癌（10.3%比 2.6%比 0.7%；P<0.001）手术后 90 天死亡率也更高。无论病理分期、Charlson-Deyo 合并症评分或肿瘤侧别如何，老年患者的总生存时间均显著短于其他 2 组。
本研究发现结直肠癌在特征、治疗和结局方面存在显著的年龄相关性差异。认识到这些差异可能是减少与年龄相关的治疗差异的第一步。
