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Efficacy of Surgery and Adjuvant Therapy in Older Patients With Colorectal Cancer A STROBE-compliant article
Sichuan University, Peoples R China; Sichuan University, Peoples R China.
Sichuan University, Peoples R China; Sichuan University, Peoples R China.
Sichuan University, Peoples R China; Sichuan University, Peoples R China.
Sichuan University, Peoples R China; Sichuan University, Peoples R China.
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2014 (English)In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 93, no 28Article in journal (Refereed) Published
Abstract [en]

The present study aimed to assess the efficacy of surgery and adjuvant therapy in older patients (age greater than= 70 years) with colorectal cancer (CRC). Older CRC patients are under-represented in available clinical trials, and therefore their outcomes after receiving surgery and adjuvant therapy are unclear. From two prospective Swedish databases, we assessed a cohort of 1021 patients who underwent curative surgery for stage I, II, or III primary CRC, with or without adjuvant chemotherapy/ radiotherapy. Of the patients with colon cancer (n = 467), 182 (39%) were aged less than70 years, 162 (35%) aged 70 to 80 years, and 123 (26%) were aged greater than= 80 years. Of rectal cancer patients (n = 554), 264 (48%) were aged less than70 years, 234 (42%) aged 70 to 80 years, and 56 (10%) aged greater than= 80 years. Older patients with either colon or rectal cancer had higher comorbidity than did younger patients. Older patients with colon cancer had equivalent postoperative morbidity and 30-day mortality to younger patients. Rectal cancer patients aged greater than= 80 years had a higher 30-day mortality than younger patients (odds ratio OR], 2.37; 95% confidence interval CI], 1.6-4.55; P = 0.03). For either colon or rectal cancer, adjuvant chemotherapy compromised the 5-year overall survival (OS) of older patients with stage II disease and had no effect on those with stage III disease. Receiving adjuvant chemotherapy was a poor factor of OS for older patients with either colon (HR 1.88, 95% CI: 1.20-4.35, P = 0.03) or rectal cancer (HR 1.72, 95% CI: 1.052.26, P = 0.004). Preoperative short-course radiotherapy improved both OS and local control for older patients with stage III rectal cancer and had no effect on those with stage II disease. Radiotherapy was a favorable factor for the OS of the older patients with rectal cancer (HR 0.42, 95% CI: 0.21-3.57, P = 0.01). In conclusion, Older CRC patients had equal safety of surgery as younger patients, except rectal cancer patients aged greater than= 80 years that had a higher mortality. Adjuvant 5FU-based chemotherapy did not benefit older CRC patient, while neoadjuvant radiotherapy improved the prognosis of older patients with stage III rectal cancer.

Place, publisher, year, edition, pages
Lippincott, Williams andamp; Wilkins , 2014. Vol. 93, no 28
Keyword [en]
colorectal neoplasm; surgery; adjuvant chemotherapy; neoadjuvant radiotherapy; survival; recurrence
National Category
Cancer and Oncology Surgery
Identifiers
URN: urn:nbn:se:liu:diva-113578DOI: 10.1097/MD.0000000000000266ISI: 000346762200026PubMedID: 25526455OAI: oai:DiVA.org:liu-113578DiVA: diva2:783033
Note

Funding Agencies|Swedish Cancer Foundation; Swedish Research Council; Health Research Council in the South-East of Sweden; Natural Science Foundation of China [81472304]

Available from: 2015-01-23 Created: 2015-01-23 Last updated: 2017-12-05

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Adell, GunnarAlbertsson, MariaArbman, GunnarSun, Xiao-Feng
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Division of Clinical SciencesFaculty of Health SciencesDepartment of OncologyDepartment of Surgery in Norrköping
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