Karaoğlan Beliz Bahar, Akkuş Erman, Kayaalp Mehmet, Akyol Cihangir, Erkek Ayhan Bülent, Akbulut Hakan, Utkan Güngör
Department of Medical Oncology, Faculty of Medicine, Ankara University, Ankara, Türkiye.
Ankara University Cancer Research Institute, Ankara, Türkiye.
Clin Transl Oncol. 2025 May;27(5):2292-2306. doi: 10.1007/s12094-024-03758-0. Epub 2024 Oct 28.
Geriatric patients account for nearly half of new colorectal cancer (CRC) cases. This study compares clinicopathological features, treatments, outcomes, and frailty in elderly (≥ 70) and younger (< 70) CRC patients at our center.
Patients diagnosed with non-metastatic or de novo metastatic CRC between January 2015 and April 2024 were included. Demographic, pathological, and survival data were retrospectively collected. Analyses were performed using SPSS version 25, with statistical significance set at P < 0.05.
Of the 414 non-metastatic CRC patients, 26.6% were aged ≥ 70. Elderly patients received less perioperative chemotherapy (60% vs. 81.6%, P < 0.001) and had more dose reductions (41.6% vs. 19.2%, P < 0.001). Frailty reduced perioperative chemotherapy in elderly non-metastatic patients (54.5% vs. 92.1%, P < 0.001) but did not affect dose reduction (37.9% vs. 33.3%, P = 0.764) or treatment duration (median 24 weeks for both groups, P = 0.909). In metastatic patients, frailty shortened chemotherapy duration (9.5 vs. 15.5 weeks, P = 0.129). Elderly patients had lower 5- and 8-year overall survival (OS) rates (64.7%, 60.1% vs. 83.0%, 78.8%, P = 0.004). In the de novo metastatic cohort (135 patients), age did not affect OS (19.4 vs. 17.3 months, P = 0.590) or PFS (9.8 vs. 7.5 months, P = 0.209). Rectal cancer (HR: 2.751, P = 0.005) and early chemotherapy termination (HR: 4.138, P < 0.001) worsened OS in non-metastatic CRC, while absence of RAS (HR: 2.043, P = 0.047), BRAF mutations (HR: 8.263, P = 0.010), and metastasectomy (HR: 3.650, P = 0.036) improved OS in metastatic CRC.
Age does not independently worsen CRC survival, though early chemotherapy discontinuation impacts outcomes. Reduced-dose chemotherapy or monotherapy can help minimize adverse effects in elderly patients.
老年患者占新发性结直肠癌（CRC）病例的近一半。本研究比较了我院中心老年（≥70岁）和年轻（<70岁）CRC患者的临床病理特征、治疗方法、治疗结果和虚弱情况。
纳入2015年1月至2024年4月期间诊断为非转移性或新发转移性CRC的患者。回顾性收集人口统计学、病理学和生存数据。使用SPSS 25版进行分析，设定统计学显著性为P<0.05。
在414例非转移性CRC患者中，26.6%的患者年龄≥70岁。老年患者接受围手术期化疗的比例较低（60%对81.6%，P<0.001），且剂量减少的情况更多（41.6%对19.2%，P<0.001）。虚弱状态降低了老年非转移性患者的围手术期化疗比例（54.5%对92.1%，P<0.001），但不影响剂量减少情况（37.9%对33.3%，P=0.764）或治疗持续时间（两组中位数均为24周，P=0.909）。在转移性患者中，虚弱状态缩短了化疗持续时间（9.5周对15.5周，P=0.129）。老年患者的5年和8年总生存率（OS）较低（64.7%、60.1%对83.0%、78.8%，P=0.004）。在新发转移性队列（135例患者）中，年龄不影响OS（19.4个月对17.3个月，P=0.590）或无进展生存期（PFS）（9.8个月对7.5个月，P=0.209）。直肠癌（HR：2.751，P=0.005）和早期化疗终止（HR：4.138，P<0.001）会使非转移性CRC的OS恶化，而RAS缺失（HR：2.043，P=0.047）、BRAF突变缺失（HR：8.263，P=0.010）和转移灶切除术（HR：3.650，P=0.036）可改善转移性CRC的OS。
年龄本身并不会独立地使CRC生存率恶化，但早期化疗中断会影响治疗结果。降低剂量的化疗或单一疗法有助于将老年患者的不良反应降至最低。
