Butare Annmarie, Hao Scarlett, Taha Anas, Honaker Michael Drew
Department of Surgery, East Carolina University Brody School of Medicine, Greenville, NC, USA.
Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Basel, Switzerland.
Int J Colorectal Dis. 2025 Jul 1;40(1):148. doi: 10.1007/s00384-025-04940-8.
Total mesorectal excision (TME) remains the primary recommended treatment for high-risk T1 and T2 rectal cancer. However, growing evidence suggests preoperative therapy may lead to eligibility for organ preservation (OP), avoiding the morbidity of major resection, which may be beneficial in older adults. The primary aim of the study was to compare rates of OP in adults 70 years of age and older to those less than 70 with T1 lesions rectal cancers with high-risk features and T2 rectal cancers.
A retrospective, cohort study of patients with high-risk stage 1 rectal cancer was identified within the National Cancer Database (NCDB). Primary outcome was the association of age with receipt of organ preservation. Multivariate analysis was conducted to examine the effect of covariates on the outcome.
Out of 38,714 patients, 34.4% were ≥ 70 years, 42.3% were female, and 75.6% had a Charlson Deyo comorbidity score of 0. Older adults were more likely to received OP compared to younger patients (45.6% vs 30.6%, p < 0.001). This persisted on adjusted analysis (OR 1.9, p < 0.001). Other factors predictive of receiving OP include non-Hispanic Black race/ethnicity (OR 1.5, p < 0.001), lack of insurance (OR 1.5, p < 0.001), increased comorbidity score (OR 1.7 for CDCC of 3, p < 0.001), treatment at a community facility compared to academic facility (OR 1.4, p < 0.001), and female sex (OR 1.2, p < 0.001).
Although current guideline recommendations for high-risk T1 and T2 rectal cancer is TME, a significantly higher proportion of older adult patients undergo organ preservation. This is more pronounced in comorbid and disadvantaged patients.
全直肠系膜切除术（TME）仍然是高危T1和T2期直肠癌的主要推荐治疗方法。然而，越来越多的证据表明，术前治疗可能会使患者符合器官保留（OP）的条件，避免大手术带来的并发症，这对老年人可能有益。本研究的主要目的是比较70岁及以上成年人与70岁以下具有高危特征的T1期直肠癌和T2期直肠癌患者的器官保留率。
在国家癌症数据库（NCDB）中对高危1期直肠癌患者进行了一项回顾性队列研究。主要结局是年龄与接受器官保留之间的关联。进行多变量分析以检查协变量对结局的影响。
在38714例患者中，34.4%年龄≥70岁，42.3%为女性，75.6%的Charlson Deyo合并症评分为0。与年轻患者相比，老年患者更有可能接受器官保留（45.6%对30.6%，p<0.001）。在调整分析中这一情况仍然存在（OR 1.9，p<0.001）。其他预测接受器官保留的因素包括非西班牙裔黑人种族/族裔（OR 1.5，p<0.001）、缺乏保险（OR 1.5，p<0.001）、合并症评分增加（CDCC为3时OR 1.7；p<0.001）、与学术机构相比在社区机构接受治疗（OR 1.4，p<0.001）以及女性（OR 1.2，p<0.001）。
尽管目前高危T1和T2期直肠癌的指南推荐是TME，但老年患者接受器官保留的比例明显更高。这在合并症患者和弱势群体中更为明显。
