Mun Ji-Yeon, Han Kyungdo, Yoo Nina, Kye Bong-Hyeon, Lee InKyu
Department of Surgery, The Catholic University of Korea, St. Vincent's Hospital, Suwon, the Republic of Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea.
BMC Cancer. 2025 Sep 2;25(1):1413. doi: 10.1186/s12885-025-14863-w.
Colorectal cancer (CRC) predominantly affects the elderly, with a growing demand for evidence-based treatment strategies in this population. The influence of comorbidities and frailty on survival outcomes following postoperative chemotherapy in elderly CRC patients remains unclear.
From the Korean National Health Insurance database, we analyzed 200,000 randomly sampled colorectal cancer patients (C18-20) diagnosed between 2009 and 2016. Patients under 20, those with inflammatory bowel disease, preoperative chemotherapy (except neoadjuvant chemoradiotherapy for rectal cancer), missing data, or death within 6 months post-surgery were excluded. Cox proportional hazards models estimated hazard ratios (HRs) for overall survival, adjusted for demographic factors. Subgroup and interaction analyses assessed effect modification by age, sex, and income. Incidence rates were reported per 1,000 person-years.
Among 2,142 patients, 44.2% received postoperative chemotherapy. Chemotherapy recipients were younger and had lower overall mortality in the unadjusted analysis. However, after adjustment, postoperative chemotherapy was associated with an increased risk of mortality (adjusted hazard ratio [HR] 1.44, 95% CI: 1.10-1.87) in patients aged ≥ 70 years. The impact of chemotherapy on survival was more pronounced in younger patients. Comorbidity and frailty emerged as significant prognostic factors, potentially outweighing the benefits of adjuvant therapy in the elderly.
In elderly CRC patients, comorbidity and frailty may play a dominant role in determining overall survival, potentially exceeding the impact of tumor-directed treatments such as postoperative chemotherapy. These findings highlight the need for comprehensive geriatric assessment and individualized treatment planning in this population.
结直肠癌（CRC）主要影响老年人，对这一人群基于证据的治疗策略的需求日益增长。合并症和虚弱对老年CRC患者术后化疗生存结局的影响仍不清楚。
从韩国国家健康保险数据库中，我们分析了2009年至2016年间随机抽取的200,000例结直肠癌患者（C18 - 20）。排除20岁以下患者、患有炎症性肠病的患者、术前化疗患者（直肠癌新辅助放化疗除外）、数据缺失患者或术后6个月内死亡患者。Cox比例风险模型估计总生存的风险比（HRs），并对人口统计学因素进行调整。亚组分析和交互作用分析评估年龄、性别和收入对效应的修正作用。发病率按每1000人年报告。
在2142例患者中，44.2%接受了术后化疗。在未调整分析中，接受化疗的患者更年轻且总体死亡率更低。然而，调整后，年龄≥70岁的患者术后化疗与死亡风险增加相关（调整后风险比[HR] 1.44，95% CI：1.10 - 1.87）。化疗对年轻患者生存的影响更为明显。合并症和虚弱成为显著的预后因素，可能超过老年患者辅助治疗的益处。
在老年CRC患者中，合并症和虚弱可能在决定总生存方面起主导作用，可能超过术后化疗等肿瘤导向治疗的影响。这些发现凸显了对这一人群进行全面老年评估和个体化治疗规划的必要性。
