Fernando Dhanushke, Hanna Joseph, Cohen Ryan, Ryan Jennifer
Department of General Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia.
Medical School, The University of Western Australia, Perth, Western Australia, Australia.
ANZ J Surg. 2024 Feb;94(1-2):181-186. doi: 10.1111/ans.18715. Epub 2023 Sep 29.
The Australian population is ageing, with an increasing number of patients diagnosed with colorectal cancer in their eighth decade. This group represents a challenging cohort to deliver multidisciplinary care, with increased morbidity and mortality related to surgical and oncological therapies. This project aimed to compare surgical and oncological outcomes in octogenarian and non-octogenarian patients with colorectal cancer.
A matched case-control retrospective review of a prospectively maintained institutional database of colorectal cancer patients treated between 2005 and 2021 was conducted. Patient demographics, treatment details, peri-operative complications, and long-term survival were reported. The primary outcome, cancer-specific survival, was investigated using time-to-event analysis and interrogated with multivariate regression.
There were 747 patients included in the study. There was no difference in five-year cancer-specific survival and recurrence-free survival between cohorts. Multivariate analysis for octogenarians confirmed a significant hazard signal associated with worsening cancer stage and a survival benefit associated with the administration of adjuvant therapy. However, we noted that stage-matched octogenarian patients received less adjuvant treatment compared to non-octogenarians.
Octogenarians undergoing treatment for colorectal cancer have similar cancer-specific survival and recurrence-free survival to non-octogenarians. Our study demonstrates a survival benefit when adjuvant therapy is provided to octogenarians, despite only half of this cohort receiving therapy compared to their younger peers. Further research into adjuvant therapy with surgical resection for CRC in older Australians is required.
澳大利亚人口正在老龄化，八十多岁被诊断为结直肠癌的患者数量不断增加。这一群体是提供多学科护理的具有挑战性的队列，与手术和肿瘤治疗相关的发病率和死亡率增加。本项目旨在比较八十多岁和非八十多岁结直肠癌患者的手术和肿瘤学结果。
对2005年至2021年期间前瞻性维护的机构结直肠癌患者数据库进行匹配病例对照回顾性研究。报告了患者的人口统计学、治疗细节、围手术期并发症和长期生存情况。主要结局，即癌症特异性生存，采用事件发生时间分析进行研究，并通过多变量回归进行分析。
该研究纳入了747名患者。队列之间的五年癌症特异性生存和无复发生存没有差异。对八十多岁患者的多变量分析证实，与癌症分期恶化相关的显著风险信号以及与辅助治疗相关的生存获益。然而，我们注意到，与非八十多岁患者相比，分期匹配的八十多岁患者接受的辅助治疗较少。
接受结直肠癌治疗的八十多岁患者与非八十多岁患者具有相似的癌症特异性生存和无复发生存。我们的研究表明，尽管与年轻同龄人相比，这一队列中只有一半的人接受了治疗，但为八十多岁患者提供辅助治疗仍有生存获益。需要对澳大利亚老年患者结直肠癌手术切除联合辅助治疗进行进一步研究。
