Warning: fopen(/home/virtual/colon/journal/upload/ip_log/ip_log_2024-10.txt): failed to open stream: Permission denied in /home/virtual/lib/view_data.php on line 95 Warning: fwrite() expects parameter 1 to be resource, boolean given in /home/virtual/lib/view_data.php on line 96 Oncologic outcomes and associated factors of colon cancer patients aged 70 years and older ;"/> ;"/>
Skip Navigation
Skip to contents

Ann Coloproctol : Annals of Coloproctology

OPEN ACCESS
SEARCH
Search
Advanced Search
mobile menu button

Articles

Page Path
HOME > Ann Coloproctol > Ahead of print > Article
Original Article
 Oncologic outcomes and associated factors of colon cancer patients aged 70 years and older
Byeo Lee Lim1orcid, In Ja Park1orcid, Jun-Soo Ro2orcid, Young Il Kim1orcid, Seok-Byung Lim1orcid, Chang Sik Yu3orcid

DOI: https://doi.org/10.3393/ac.2023.00367.0052
Published online: August 5, 2024

1Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

2Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea

3Department of Colon and Rectal Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea

Correspondence to: In Ja Park, MD, PhD Department of Colon and Rectal Surgery, Asan Medical Center, University of College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Email: ipark@amc.seoul.kr
• Received: June 7, 2023   • Revised: August 23, 2023   • Accepted: September 11, 2023

Copyright © 2023 The Korean Society of Coloproctology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

  • 602 Views
  • 10 Download
Full Article

Download PDF Download PDF

  • Purpose
    The aim of this study was to examine the prognosis and associated risk factors, including adjuvant chemotherapy (CTx), in elderly patients with colon cancer.
  • Methods
    This retrospective study included patients who underwent radical resection for colon cancer between January 2010 and December 2014 at Asan Medical Center. The effects of stage, risk factors, and chemotherapy on overall survival (OS) and recurrence-free survival (RFS) were compared in patients aged ≥70 and <70 years.
  • Results
    Of 3,313 patients, 933 (28.1%) was aged ≥70 years. Of the 1,921 patients indicated for adjuvant CTx, 1,294 of 1,395 patients (92.8%) aged <70 years and 369 of 526 patients (70.2%) aged ≥70 years received adjuvant CTx. Old age (≥70 years) was independently associated with RFS in overall cohort. Among patients aged ≥70 years indicated for adjuvant CTx, the 5-year OS (81.6% vs. 50.4%, P<0.001) and RFS (82.9% vs. 67.4%, P=0.025) rates were significantly higher in those who did than did not receive adjuvant CTx. Additionally, adjuvant CTx was confirmed as an independent risk factor of both OS and RFS in patients aged ≥70 years indicated for adjuvant CTx.
  • Conclusion
    Old age was associated with poor RFS and adjuvant CTx had benefits in OS as well as RFS in elderly patients eligible for adjuvant CTx.
  • Keywords: Aged; Colonic neoplasms; Adjuvant chemotherapy; Prognosis
Colorectal cancer is the third most common cancer worldwide after breast and lung cancers and the second most common cause of cancer-related deaths after lung cancer [1]. Increases in the elderly population have been accompanied by increases in the proportion of elderly persons with colorectal cancer, with about 60% of colon cancer patients diagnosed at age ≥65 years. In addition, the mortalities of patients aged 60 years or older have been increasing, comprising 83.5% of all colorectal cancer-related deaths [2]. Therefore, the screening, treatment and prognosis of elderly patients with colorectal cancer are social concerns [3–6].
Studies regarding the prognosis and treatment of elderly colorectal cancer patients have yielded conflicting results. For example, several studies have reported that patient prognosis was poor, even with active treatment [7, 8], whereas other studies found that treatment improved prognosis [9, 10]. Various factors have been found to affect prognosis including underlying diseases, general performance status, and comorbidities, making it challenging to establish treatment guidelines for elderly patients. Age-related physiological changes, such as organ decline, comorbidities, and functional deterioration, create a distinct set of obstacles. Cancer itself adds another level of difficulty to the aging process, as older adults with cancer are more likely to experience impairments in their capacity to take care of themselves, have poorer self-rated health, and have additional age-related syndromes, such as cognitive impairments and falls. Several studies have therefore analyzed methods of enhancing physical and mental performance and of accurately assessing performance in elderly cancer patients [11, 12].
Improving the prognosis of elderly patients may result in overall improvements in the prognosis of all patients with colorectal cancer as the proportion of elderly patients increases. The present study therefore retrospectively investigated the prognosis in elderly patients with colon cancer and assessed the effects of factors, including adjuvant chemotherapy, on patient prognosis. These findings may assist in establishing guidelines for treatment of elderly patients
Ethics statement
The study protocol was approved by the Institutional Review Board of Asan Medical Center (No. 2022-1171). The requirmenet for informed consent was waived due to the retrospective nature of the study. The study was conducted in accordance with the ethical principles of the 1964 Declaration of Helsinki.
Patients
The records of consecutive patients who underwent curative surgery for colon cancer between January 2010 and December 2014 at Asan Medical Center (Seoul, Korea), were reviewed retrospectively. Clinicopathologic features, pathologic staging, adjuvant chemotherapy (CTx), recurrence, and survival were recorded. Patients were included if they were diagnosed with histologically confirmed colon cancer and underwent curative resection. Patients with rectal cancer, concurrent or prior malignancies, and distant metastases, as well as those who did not undergo surgical treatment, were excluded. Patients aged ≥70 years were defined as elderly, whereas those aged <70 years were defined as nonelderly.
Radical resection including primary tumor and mesocolon was performed. The extent of surgery was not affected by age. Adjuvant CTx was recommended for patients with pathologic stage III colon cancer and for patients with pathologic stage II colon cancer with high-risk features such as preoperative obstruction, including both endoscopic obstruction and clinically total obstruction; inadequate lymph node examination (<12 lymph nodes retrieved); lymphovascular invasion (LVi); perineural invasion (PNi); histologically poor differentiation; high tumor budding; or resection margin involvement. The final decision to administer adjuvant CTx was determined after discussions among medical oncologist, surgeon, and patient, with considerations including pathologic report, the general health condition, family support, and socioeconomic status of each patient.
Surveillance
Patients were followed up every 3 to 12 months for up to 5 years after surgery. Follow-up evaluations included physical examination, blood tests, including measurements of carcinoembryonic antigen (CEA) levels, and abdominopelvic, and/or chest computed tomography (CT). These CT scans were performed every 6 to 12 months. Patients were evaluated by colonoscopy within 1 year after surgery and then once every 2 or 3 years. Patients with preoperative obstruction underwent colonoscopy within 6 months after surgery.
Statistical analysis
Recurrence-free survival (RFS) was defined as the time from the date of surgery to the date of tumor recurrence or last date of follow-up. Overall survival (OS) was defined as the time from the date of surgery to the date of death from any cause (not cancer-specific death) or last date of follow-up. Categorical variables were compared using chi-square test and continuous variables were compared using t-test. OS and RFS were determined using the Kaplan-Meier method and compared by log-rank test. Multivariable Cox proportional hazards analyses were used to evaluate risk factors associated with RFS, including age, sex, LVi, PNi, pathologic staging, and adjuvant CTx. Risk factors associated with OS was also analyzed in patients aged ≥70 years. All statistical analyses were performed using IBM SPSS ver. 21.0 (IBM Corp), with P-values of <0.05 considered statistically significant.
Patient characteristics
During the study period, 3,313 patients, including 1,888 men (56.9%) and 1,425 women (43.1%), underwent R0 surgical resection for colon cancer. The mean age was 61.4±11.4 years. LVi was present in 893 patients (26.9%) and PNi in 579 (17.4%). Pathologically, most patients (77.3%) had moderately differentiated tumors, with the more common primary tumor site being the left colon (56.5%). The mean number of harvested lymph nodes was 27.7±13.9, with <12 lymph nodes harvested from about 2% of all patients. Of 3,313 patients, 933 (28.2%) were aged ≥70 years and 2,380 (71.8%) were aged <70 years.
The demographic and clinicopathologic characteristics of the 2 age groups are presented in Table 1. Pathologic stage was differently distributed among 2 groups (P<0.001). The percentage of patients with stages I and III colon cancer was significantly higher in the nonelderly than in the elderly group. The LVi was significantly common (P=0.003), but the PNi was less (P=0.003) in the elderly group. Less patients in the elderly than in the nonelderly group received adjuvant CTx (P<0.001). Of 3,313 patients, 1,921 (58.0%) were indicated for adjuvant CTx, and among those who indicated for adjuvant CTx, 1,663 patients (86.6%) received adjuvant CTx. Patients who received adjuvant CTx among patients indicated adjuvant CTx was significantly lower (P<0.001) in elderly patients (70.2%) than nonelderly patients (92.8%). Of 124 elderly patients who were indicated for adjuvant CTx but did not receive adjuvant CTx, the proportion of patients according to the reason for not implementing adjuvant CTx is as follows: recommendation of medical oncologist (n=47), patient and family reluctant to CTx (n=49), and follow-up loss or unknown (n=28).
Oncologic outcomes and associated factors in the overall cohort
The 5-year RFS rate was significantly higher in the nonelderly (89.8%) than in the elderly (86.4%) group (P<0.001). When analyzing the survival rate according to the staging, there was no significant difference between 2 groups in stage I (97.5% vs. 96.3%, P=0.391) and stage III (80.6% vs. 75.9%, P=0.100). The 5-year RFS rate, however, was significantly higher in the nonelderly than in the elderly patients with stage II colon cancer with high-risk features (91.7% vs. 85.4%, P=0.004) (Fig. 1). Multivariable analysis found that age, LVi, PNi, and stage were significantly associated with RFS, whereas CTx and sex were not (Table 2).
Oncologic outcomes and associated factors in the elderly group
In elderly group, patients who received adjuvant CTx showed higher 5-year OS rates (81.6% vs. 74.6%, P=0.014) than patients who were not treated with adjuvant CTx (Fig. 2). According to the subgroup analysis of elderly group by stage, patients receiving adjuvant CTx showed significantly higher 5-year OS rates in both high-risk stage II (83.4% vs. 67.2%, P=0.02) and stage III (80.3% vs. 27.5%, P<0.001) colon cancer than those who did not receive adjuvant CTx (Fig. 2).
The 5-year RFS rate in the elderly group was significantly lower in patients who received adjuvant CTx than those who did not receive adjuvant CTx (83.0% vs. 89.0%, P=0.027). However, among patients indicated for adjuvant CTx, the 5-year RFS rate was higher in patients treated with adjuvant CTx than those who did not (82.9% vs. 67.4%, P=0.024) (Fig. 3B). The 5-year RFS rate was significantly higher in elderly patients with stage III colon cancer who did than did not receive adjuvant CTx (79.9% vs. 41.4% P=0.001) (Fig. 3D), although these rates did not differ in elderly patients with high-risk stage II colon cancer (80.0% vs. 87.6%, P=0.517) (Fig. 3C).
In elderly patients, tumor stage and adjuvant CTx were significantly associated with both OS and RFS. Additionally, LVi and PNi were associated with RFS but not with OS (Table 3). In elderly patients who were indicated for adjuvant CTx, adjuvant CTx was significantly associated with OS and RFS. Tumor stage was associated with RFS but not with OS (Supplementary Table 1).
The present study found that elderly colon cancer patients showed significantly lower RFS than nonelderly patients. Insufficient adjuvant CTx treatment in patients who indicated for adjuvant CTx might be responsible for poor oncologic outcome because adjuvant CTx was associated with OS and RFS in elderly patients indicated for adjuvant CTx. Because overall death rates are naturally higher in the elderly than in the nonelderly, this may affect the comparisons of OS rates in the entire study population. Therefore, only RFS between the elderly and the nonelderly was compared and analyzed its risk factors in the entire cohort.
Old age is a contextual concept that cannot be uniformly defined. Discrepancies between chronological age and biological age and interindividual differences in the aging process complicate the determination of standard definitions. Research studies have utilized various definitions of old age [13–15]. A survey by the Cabinet Office of the Japanese Government found that many people regard an age of >70 or 75 years as elderly [16], with these cutoffs adjustable for populations in other developed eastern countries. The present study therefore defined persons aged ≥70 as elderly.
The effects of old age on prognosis of colorectal cancer have been reported inconsistently [17–20]. Some reported that oncologic outcomes, especially late period survival, were similar in younger and older patients with resectable colorectal cancer [18], whereas other studies reported that prognosis was poorer in elderly than in younger patients with colorectal cancer [19, 20]. One of the suggested reasons is that delayed diagnosis of colon cancer of more advanced stage was comprised in elderly patients. The multimodal adjuvant therapy was less given in the elderly [21] and may cause medical comorbidities, which are more frequent in the elderly than in younger patients [22, 23]. Multivariable analyses in the present study found that age was a significant risk factor for RFS and that prognosis in elderly patients varied depending on whether adjuvant CTx was administered considering the pathologic stage.
Elderly patients, even those without additional comorbidities or poor general performance status, tend to avoid aggressive treatment. In the present study, 39.5% of elderly patients who did not receive adjuvant CTx among the indicated adjuvant CTx group had no specific medical reason to avoid adjuvant CTx. On the other hand, 37.9% of patients were recommended not to undergo adjuvant treatment by a medical oncologist. Some studies reported that more than 50% of patients with indications for adjuvant CTx did not receive treatment [24–26]. Although it is higher than previous reports, only 70.2% of elderly patients with indications for adjuvant CTx received treatment, with the proportion being lower in the high-risk stage II group (62.3%) than in the stage III group (76.2%). The efficacy of adjuvant CTx in patients with high-risk stage II colon cancer remains unclear. Several trials [27–29] have reported that adjuvant CT was not associated with improved OS or disease-free survival rates in patients aged ≥70 years with stage II colon cancer, whereas another trial [30] found that adjuvant CTx in these patients was associated with improved prognosis. Additionally, the number of risk features has been associated with survival in patients with high-risk stage II colon cancer, with adjuvant CTx reported to benefit some patients with 3 or more high-risk features [31]. The survival benefit of adjuvant CTx in stage III disease is more evident and generally accepted, and more elderly patients with stage III disease would receive adjuvant CTx than elderly with high-risk stage II disease.
The present study found that age was a key determinant of OS and RFS, and that adjuvant CTx was associated with improved oncologic outcomes in elderly patients. These findings assume that active treatment would improve oncologic outcomes including RFS and OS in elderly patients.
The toxicities of adjuvant CTx may be of particular concern in elderly patients. CTx has various adverse effects, including nausea, vomiting, fatigue, rash, and peripheral neuropathy. Moreover, the toxicities of CTx can be lethal, especially in elderly patients with poor general performance status or other severe comorbidities [32, 33]. Most elderly patients with cancer, however, can tolerate CTx, although some may require dose reductions [34, 35]. The present study showed that, among patients aged ≥70 years with indications for adjuvant CTx, those who received adjuvant CTx had a higher RFS rate than those who did not. If the toxicities of CTx affect all elderly patients lethally, OS may be compromised. However, the present study found that patients who received CTx aged ≥70 years, had a higher OS rate than those who did not, suggesting that the efficacy of CTx has a greater effect than its toxicities on oncologic outcomes in elderly patients. Indeed, based on the anesthesiology record sheets, there was no significant difference in the American Society of Anesthesiologists (ASA) physical status (PS) grade between patients who received CTx and those who did not within the high-risk stage II group (P=0.126), stage III group (P=0.126), and group indicated for CTx (P=0.073) among the elderly patients. These findings suggest that old age itself becomes a hindering factor for adjuvant CTx, not necessarily due to medical problem, but rather due to negative assumptions about the adverse effects of adjuvant CTx in elderly colon cancer patients.
The present study had some limitations, including its retrospective and nonrandomized design, which may have introduced selection biases. Although the ASA PS grade was reported, the detailed health condition could not be assessed sufficiently and the reason why adjuvant CTx was not given could not be clearly evaluated. Moreover, the toxicity of CTx could not be evaluated in the elderly patients and could not assess the actual risk of adjuvant CTx in the elderly group. Although this study included a large number of patients, all included patients were treated at a single center. Nevertheless, this large, single-center cohort study reflects real-world practice in patients with colon cancer. The finding that elderly patients with high-risk stage II colon cancer are less likely to receive adjuvant CTx than those with stage III colon cancer may also reflect real-world practice.
In conclusion, aging was shown to be substantially associated with RFS in patients with colon cancer. Adjuvant CTx improved OS and RFS rates even in elderly colon cancer patients indicated for adjuvant CTx. More active CTx would therefore be recommended for elderly patients who are eligible for it, regardless of age. Prospective studies are required to ascertain whether active treatment can improve prognosis for elderly patients with colon cancer in practice and to establish reliable treatment guidelines for adjuvant CTx in this patient population.

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Funding

None.

Author contributions

Conceptualization: BLL, IJP; Data curation: IJP; Formal analysis: BLL, IJP; Investigation: IJP; Methodology: JSR, YIK, SBL, CSY; Project administration: BLL, IJP; Visualization: YIK, SBL, CSY; Writing–original draft: BLL, IJP; Writing–review & editing: all authors. All authors read and approved the final manuscript.

Supplementary Table 1.

Univariable and multivariable analysis of risk factors for OS and RFS in colon cancer patients aged ≥70 years who were indicated for adjuvant chemotherapy (n=526)
ac-2023-00367-0052-Supplementary-Table-1.pdf
Supplementary materials are available from https://doi.org/10.3393/ac.2023.00367.0052.
Fig. 1.
The recurrence-free survival (RFS) in nonelderly (<70 years) and elderly (≥70 years) patients according to pathologic stage. Elderly patients with stage II disease showed lower RFS. (A) Stage I colon cancer. (B) Stage II colon cancer with high-risk features. (C) Stage III colon cancer.
ac-2023-00367-0052f1.jpg
Fig. 2.
The overall survival (OS) according to adjuvant chemotherapy (CTx) treatment in the elderly group (≥70 years). Patients received adjuvant CTx showed improved OS. (A) All elderly patients. (B) Elderly patients indicated for adjuvant chemotherapy. (C) Elderly patients with stage II colon cancer with high-risk features. (D) Elderly patients with stage III colon cancer.
ac-2023-00367-0052f2.jpg
Fig. 3.
The recurrence-free survival (RFS) according to adjuvant chemotherapy (CTx) treatment in the elderly group (≥70 years). In the overall group, adjuvant CTx group showed lower RFS; however, the adjuvant CTx group showed higher RFS in patients who were indicated for adjuvant CTx. (A) All elderly patients. (B) Elderly patients indicated for adjuvant chemotherapy. (C) Elderly patients with stage II colon cancer with high-risk features. (D) Elderly patients with stage III colon cancer.
ac-2023-00367-0052f3.jpg
Table 1.
Demographic and clinicopathologic characteristics of the study population (n=3,313)
Characteristic Age group P-value
<70 yr (n=2,380) ≥70 yr (n=933)
Sex 0.726
 Male 1,361 (57.2) 527 (56.4)
 Female 1,019 (42.8) 406 (43.5)
Location <0.001
 Right colona 972 (40.8) 470 (50.4)
 Left colonb 1,408 (59.2) 463 (49.6)
Stage < 0.001
 I 661 (27.8) 199 (21.3)
 II 912 (38.3) 436 (46.7)
 III 807 (33.9) 298 (31.9)
Lymphovascular invasion 0.003
 Positive 632 (26.5) 261 (28.0)
 Negative 1,661 (69.8) 659 (70.6)
 Indeterminate 87 (3.7) 13 (1.4)
Perineural invasion 0.003
 Positive 422 (17.7) 158 (16.9)
 Negative 1,869 (78.6) 761 (81.6)
 Indeterminate 89 (3.7) 14 (1.5)
Differentiation 0.008
 Well-differentiated 371 (15.6) 127 (13.6)
 Moderately differentiated 1,846 (77.6) 714 (76.5)
 Poorly differentiated 94 (3.9) 65 (7.0)
 Otherc 69 (2.9) 27 (2.9)
Adjuvant chemotherapy <0.001
 Yes 1,302 (54.7) 370 (39.7)
 No 1,020 (42.9) 527 (56.5)
 Unknown 58 (2.4) 36 (3.9)

Values are presented as number (%)

aIncludes cecum, ascending colon, hepatic flexure, transverse colon. bIncludes splenic flexure, descending colon, sigmoid colon. cSignet ring cell, mucinous cell carcinoma.

Table 2.
Univariable and multivariable analyses of risk factors for recurrence-free survival (n=3,313)
Variable Univariable analysis
 Multivariable analysis
HR (95% CI) P-value HR (95% CI) P-value
Age (yr) 0.004 0.002
 <70 1.00 (Reference) 1.00 (Reference)
 ≥70 1.40 (1.11–1.76) 1.45 (1.15–1.83)
Location 0.399 NA NA
 Right colon 1.00 (Reference)
 Left colon 1.10 (0.89–1.36)
Sex 0.609 NA NA
 Male 1.00 (Reference)
 Female 0.95 (0.76–1.17)
Lymphovascular invasion <0.001 0.001
 No 1.00 (Reference) 1.00 (Reference)
 Yes 2.54 (2.05–3.14) 1.48 (1.18–1.86)
Perineural invasion <0.001 <0.001
 No 1.00 (Reference) 1.00 (Reference)
 Yes 3.35 (2.69–4.16) 2.21 (1.76–2.77)
Stage <0.001 <0.001
 I 1.00 (Reference) 1.00 (Reference)
 II 3.24 (2.07–5.08) 2.57 (1.61–4.10)
 III 7.90 (5.14–12.15) 5.10 (3.22–8.08)
Adjuvant chemotherapy <0.001 0.270
 No 1.00 (Reference) 1.00 (Reference)
 Yes 2.67 (2.09–3.41) 0.83 (0.61–1.15)

HR, hazard ratio; CI, confidence interval; NA, not applicable.

Table 3.
Univariable and multivariable analysis of risk factors for OS and RFS in colon cancer patients aged ≥70 years (n=933)
Variable OS
 RFS
Univariable analyisis
 Multivariable analysis
 Univariable analysis
 Multivariable analysis
HR (95% CI) P-value HR (95% CI) P-value HR (95% CI) P-value HR (95% CI) P-value
Sex 0.156 NA NA 0.261 NA NA
 Male 1.00 (Reference) 1.00 (Reference)
 Female 0.83 (0.65-1.07) 0.80 (0.54–1.18)
Location 0.415 NA NA 0.798 NA NA
 Right colon 1.00 (Reference) 1.00 (Reference)
 Left colon 1.10 (0.87–1.40) 1.05 (0.72–1.54)
Lymphovascular invasion 0.003 0.112 <0.001 0.033
 No 1.00 (Reference) 1.00 (Reference) 1.00 (Reference) 1.00 (Reference)
 Yes 1.47 (1.14–1.90) 1.26 (0.95–1.69) 2.38 (1.62–3.49) 1.58 (1.04–2.40)
Perineural invasion 0.005 0.101 <0.001 <0.001
 No 1.00 (Reference) 1.00 (Reference) 1.00 (Reference) 1.00 (Reference)
 Yes 1.52 (1.14–2.02) 1.30 (0.95–1.77) 3.56 (2.41–5.26) 2.57 (1.70–3.90)
Stage 0.011 <0.001 <0.001 <0.001
 I 1.00 (Reference) 1.00 (Reference) 1.00 (Reference) 1.00 (Reference)
 II 1.38 (0.97–1.95) 1.66 (1.16–2.39) 3.45 (1.47–8.11) 3.59 (1.47–8.75)
 III 1.73 (1.20–2.48) 2.96 (1.93–4.54) 7.47 (3.22–17.32) 7.66 (2.97–19.79)
Adjuvant chemotherapy 0.046 <0.001 0.008 0.034
 No 1.00 (Reference) 1.00 (Reference) 1.00 (Reference) 1.00 (Reference)
 Yes 0.77 (0.60–1.00) 0.49 (0.36–0.67) 1.67 (1.15–2.48) 0.61 (0.38–0.96)

OS, overall survival; RFS, recurrence-free survival; HR, hazard ratio; CI, confidence interval; NA, not applicable.

  • 1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209–49.ArticlePubMed
  • 2. Kim MH, Park S, Yi N, Kang B, Park IJ. Colorectal cancer mortality trends in the era of cancer survivorship in Korea: 2000-2020. Ann Coloproctol 2022;38:343–52.ArticlePubMedPMCPDF
  • 3. Kurniali PC, Hrinczenko B, Al-Janadi A. Management of locally advanced and metastatic colon cancer in elderly patients. World J Gastroenterol 2014;20:1910–22.ArticlePubMedPMC
  • 4. Patel SG, May FP, Anderson JC, Burke CA, Dominitz JA, Gross SA, et al. Updates on age to start and stop colorectal cancer screening: recommendations from the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2022;162:285–99.ArticlePubMed
  • 5. Chen J, Zhang C, Wu Y. Does adjuvant chemotherapy improve outcomes in elderly patients with colorectal cancer? A systematic review and meta-analysis of real-world studies. Expert Rev Gastroenterol Hepatol 2022;16:383–91.ArticlePubMed
  • 6. Drews G, Bohnsteen B, Knolle J, Gradhand E, Würl P. Laparoscopic surgery for colorectal cancer in an elderly population with high comorbidity: a single centre experience. Int J Colorectal Dis 2022;37:1963–73.ArticlePubMedPDF
  • 7. McCleary NJ, Zhang S, Ma C, Ou FS, Bainter TM, Venook AP, et al. Age and comorbidity association with survival outcomes in metastatic colorectal cancer: CALGB 80405 analysis. J Geriatr Oncol 2022;13:469–79.ArticlePubMedPMC
  • 8. Kim KH, Lee JJ, Kim J, Gomes FR, Sehovic M, Extermann M. Association of multidimensional comorbidities with survival in elderly patients with metastatic colorectal cancer treated with chemotherapy. J Clin Oncol 2017;35(15_suppl): e21530. Article
  • 9. Khalil L, Gao X, Switchenko JM, Alese OB, Akce M, Wu C, et al. Survival outcomes of adjuvant chemotherapy in elderly patients with stage III colon cancer. Oncologist 2022;27:740–50.ArticlePubMedPMCPDF
  • 10. Shaib WL, Zakka KM, Jiang R, Yan M, Alese OB, Akce M, et al. Survival outcome of adjuvant chemotherapy in deficient mismatch repair stage III colon cancer. Cancer 2020;126:4136–47.ArticlePubMedPDF
  • 11. Garcia MV, Agar MR, Soo WK, To T, Phillips JL. Screening tools for identifying older adults with cancer who may benefit from a geriatric assessment: a systematic review. JAMA Oncol 2021;7:616–27.ArticlePubMed
  • 12. Demmelmaier I, Brooke HL, Henriksson A, Mazzoni AS, Bjørke AC, Igelström H, et al. Does exercise intensity matter for fatigue during (neo-)adjuvant cancer treatment? The Phys-Can randomized clinical trial. Scand J Med Sci Sports 2021;31:1144–59.ArticlePubMedPDF
  • 13. Scherboy S, Sanderson W. New measures of population ageing. International Institute for Applied Systems Analysis (IIASA); 2019.PDF
  • 14. Kotake K, Asano M, Ozawa H, Kobayashi H, Sugihara K. Tumour characteristics, treatment patterns and survival of patients aged 80 years or older with colorectal cancer. Colorectal Dis 2015;17:205–15.ArticlePubMed
  • 15. González-Senac NM, Mayordomo-Cava J, Macías-Valle A, Aldama-Marín P, Majuelos González S, Cruz Arnés ML, et al. Colorectal cancer in elderly patients with surgical indication: state of the art, current management, role of frailty and benefits of a geriatric liaison. Int J Environ Res Public Health 2021;18:6072. ArticlePubMedPMC
  • 16. Public Relations Office; Cabinet Office. Overview of the public opinion survey on the life of the people. The Government of Japan; 2016.Japanese.PDF
  • 17. Fu J, Ruan H, Zheng H, Cai C, Zhou S, Wang Q, et al. Impact of old age on resectable colorectal cancer outcomes. PeerJ 2019;7:e6350.ArticlePubMedPMCPDF
  • 18. Dekker JW, van den Broek CB, Bastiaannet E, van de Geest LG, Tollenaar RA, Liefers GJ. Importance of the first postoperative year in the prognosis of elderly colorectal cancer patients. Ann Surg Oncol 2011;18:1533–9.ArticlePubMedPMC
  • 19. Grande C, Quintero G, Candamio S, París Bouzas L, Villanueva MJ, Campos B, et al. Biweekly XELOX (capecitabine and oxaliplatin) as first-line treatment in elderly patients with metastatic colorectal cancer. J Geriatr Oncol 2013;4:114–21.ArticlePubMed
  • 20. Kunitake H, Zingmond DS, Ryoo J, Ko CY. Caring for octogenarian and nonagenarian patients with colorectal cancer: what should our standards and expectations be? Dis Colon Rectum 2010;53:735–43.ArticlePubMed
  • 21. Lee TH, Choo JM, Kim JS, Shin SH, Kim JS, Baek SJ, et al. Characteristics and outcomes of colorectal cancer surgery by age in a tertiary center in Korea: a retrospective review. Ann Coloproctol 2022;38:244–52.ArticlePubMedPDF
  • 22. Kellokumpu I, Kairaluoma M, Mecklin JP, Kellokumpu H, Väyrynen V, Wirta EV, et al. Impact of age and comorbidity on multimodal management and survival from colorectal cancer: a population-based study. J Clin Med 2021;10:1751. ArticlePubMedPMC
  • 23. Lee SM, Shin JS. Colorectal cancer in octogenarian and nonagenarian patients: clinicopathological features and survivals. Ann Coloproctol 2020;36:323–9.ArticlePubMedPMCPDF
  • 24. Li P, Li F, Fang Y, Wan D, Pan Z, Chen G, et al. Efficacy, compliance and reasons for refusal of postoperative chemotherapy for elderly patients with colorectal cancer: a retrospective chart review and telephone patient questionnaire. PLoS One 2013;8:e55494.ArticlePubMedPMC
  • 25. Landrum MB, Keating NL, Lamont EB, Bozeman SR, McNeil BJ. Reasons for underuse of recommended therapies for colorectal and lung cancer in the Veterans Health Administration. Cancer 2012;118:3345–55.ArticlePubMed
  • 26. Lewis JH, Kilgore ML, Goldman DP, Trimble EL, Kaplan R, Montello MJ, et al. Participation of patients 65 years of age or older in cancer clinical trials. J Clin Oncol 2003;21:1383–9.ArticlePubMed
  • 27. McCleary NJ, Meyerhardt JA, Green E, Yothers G, de Gramont A, Van Cutsem E, et al. Impact of age on the efficacy of newer adjuvant therapies in patients with stage II/III colon cancer: findings from the ACCENT database. J Clin Oncol 2013;31:2600–6.ArticlePubMedPMC
  • 28. Tsai TC, Sun JL, Lin WL, Lee SW, Chang SC, Wu PH, et al. Survival of adjuvant chemotherapy among elderly patients with stage II colon cancer. Int J Gerontol 2018;12:94–9.Article
  • 29. Lee KY, Park JW, Lee KY, Cho S, Kwon YH, Kim MJ, et al. Adjuvant chemotherapy does not provide survival benefits to elderly patients with stage II colon cancer. Sci Rep 2019;9:11846. ArticlePubMedPMCPDF
  • 30. Kim MK, Won DD, Park SM, Kim T, Kim SR, Oh ST, et al. Effect of adjuvant chemotherapy on stage II colon cancer: analysis of Korean national data. Cancer Res Treat 2018;50:1149–63.ArticlePubMedPDF
  • 31. Lee Y, Park I, Cho H, Gwak G, Yang K, Bae BN. Effect of adjuvant chemotherapy on elderly stage II high-risk colorectal cancer patients. Ann Coloproctol 2021;37:298–305.ArticlePubMedPMCPDF
  • 32. Cremolini C, Schirripa M, Antoniotti C, Moretto R, Salvatore L, Masi G, et al. First-line chemotherapy for mCRC: a review and evidence-based algorithm. Nat Rev Clin Oncol 2015;12:607–19.ArticlePubMedPDF
  • 33. Marmorino F, Rossini D, Lonardi S, Moretto R, Zucchelli G, Aprile G, et al. Impact of age and gender on the safety and efficacy of chemotherapy plus bevacizumab in metastatic colorectal cancer: a pooled analysis of TRIBE and TRIBE2 studies. Ann Oncol 2019;30:1969–77.ArticlePubMedPDF
  • 34. Bohle W, Pachlhofer A, Zoller WG. Efficacy of palliative chemotherapy in elderly patients with colorectal cancer. Z Gastroenterol 2019;57:484–90.ArticlePubMed
  • 35. Sakin A, Yasar N, Sahin S, Arici S, Secmeler S, Can O, et al. Efficacy and tolerability of adjuvant therapy in ≥70-year-old patients with T3N0M0 colorectal cancer: an observational study. J Oncol Pharm Pract 2020;26:619–31.ArticlePubMedPDF

Figure & Data

References

    Citations

    Citations to this article as recorded by  

      • Cite this Article
        Cite this Article
        export Copy Download
        Close
        Download Citation
        Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
        Format:
        • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
        • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
        Include:
        • Citation for the content below
        Oncologic outcomes and associated factors of colon cancer patients aged 70 years and older
        Close
      • XML DownloadXML Download
      Figure
      • 0
      • 1
      • 2
      Oncologic outcomes and associated factors of colon cancer patients aged 70 years and older
      Image Image Image
      Fig. 1. The recurrence-free survival (RFS) in nonelderly (<70 years) and elderly (≥70 years) patients according to pathologic stage. Elderly patients with stage II disease showed lower RFS. (A) Stage I colon cancer. (B) Stage II colon cancer with high-risk features. (C) Stage III colon cancer.
      Fig. 2. The overall survival (OS) according to adjuvant chemotherapy (CTx) treatment in the elderly group (≥70 years). Patients received adjuvant CTx showed improved OS. (A) All elderly patients. (B) Elderly patients indicated for adjuvant chemotherapy. (C) Elderly patients with stage II colon cancer with high-risk features. (D) Elderly patients with stage III colon cancer.
      Fig. 3. The recurrence-free survival (RFS) according to adjuvant chemotherapy (CTx) treatment in the elderly group (≥70 years). In the overall group, adjuvant CTx group showed lower RFS; however, the adjuvant CTx group showed higher RFS in patients who were indicated for adjuvant CTx. (A) All elderly patients. (B) Elderly patients indicated for adjuvant chemotherapy. (C) Elderly patients with stage II colon cancer with high-risk features. (D) Elderly patients with stage III colon cancer.

      Fig. 1.

      Fig. 2.

      Fig. 3.

      Oncologic outcomes and associated factors of colon cancer patients aged 70 years and older
      Characteristic Age group P-value
      <70 yr (n=2,380) ≥70 yr (n=933)
      Sex 0.726
       Male 1,361 (57.2) 527 (56.4)
       Female 1,019 (42.8) 406 (43.5)
      Location <0.001
       Right colona 972 (40.8) 470 (50.4)
       Left colonb 1,408 (59.2) 463 (49.6)
      Stage < 0.001
       I 661 (27.8) 199 (21.3)
       II 912 (38.3) 436 (46.7)
       III 807 (33.9) 298 (31.9)
      Lymphovascular invasion 0.003
       Positive 632 (26.5) 261 (28.0)
       Negative 1,661 (69.8) 659 (70.6)
       Indeterminate 87 (3.7) 13 (1.4)
      Perineural invasion 0.003
       Positive 422 (17.7) 158 (16.9)
       Negative 1,869 (78.6) 761 (81.6)
       Indeterminate 89 (3.7) 14 (1.5)
      Differentiation 0.008
       Well-differentiated 371 (15.6) 127 (13.6)
       Moderately differentiated 1,846 (77.6) 714 (76.5)
       Poorly differentiated 94 (3.9) 65 (7.0)
       Otherc 69 (2.9) 27 (2.9)
      Adjuvant chemotherapy <0.001
       Yes 1,302 (54.7) 370 (39.7)
       No 1,020 (42.9) 527 (56.5)
       Unknown 58 (2.4) 36 (3.9)
      Variable Univariable analysis
      		 Multivariable analysis
      HR (95% CI) P-value HR (95% CI) P-value
      Age (yr) 0.004 0.002
       <70 1.00 (Reference) 1.00 (Reference)
       ≥70 1.40 (1.11–1.76) 1.45 (1.15–1.83)
      Location 0.399 NA NA
       Right colon 1.00 (Reference)
       Left colon 1.10 (0.89–1.36)
      Sex 0.609 NA NA
       Male 1.00 (Reference)
       Female 0.95 (0.76–1.17)
      Lymphovascular invasion <0.001 0.001
       No 1.00 (Reference) 1.00 (Reference)
       Yes 2.54 (2.05–3.14) 1.48 (1.18–1.86)
      Perineural invasion <0.001 <0.001
       No 1.00 (Reference) 1.00 (Reference)
       Yes 3.35 (2.69–4.16) 2.21 (1.76–2.77)
      Stage <0.001 <0.001
       I 1.00 (Reference) 1.00 (Reference)
       II 3.24 (2.07–5.08) 2.57 (1.61–4.10)
       III 7.90 (5.14–12.15) 5.10 (3.22–8.08)
      Adjuvant chemotherapy <0.001 0.270
       No 1.00 (Reference) 1.00 (Reference)
       Yes 2.67 (2.09–3.41) 0.83 (0.61–1.15)
      Variable OS
      		 RFS
      Univariable analyisis
      		 Multivariable analysis
      		 Univariable analysis
      		 Multivariable analysis
      HR (95% CI) P-value HR (95% CI) P-value HR (95% CI) P-value HR (95% CI) P-value
      Sex 0.156 NA NA 0.261 NA NA
       Male 1.00 (Reference) 1.00 (Reference)
       Female 0.83 (0.65-1.07) 0.80 (0.54–1.18)
      Location 0.415 NA NA 0.798 NA NA
       Right colon 1.00 (Reference) 1.00 (Reference)
       Left colon 1.10 (0.87–1.40) 1.05 (0.72–1.54)
      Lymphovascular invasion 0.003 0.112 <0.001 0.033
       No 1.00 (Reference) 1.00 (Reference) 1.00 (Reference) 1.00 (Reference)
       Yes 1.47 (1.14–1.90) 1.26 (0.95–1.69) 2.38 (1.62–3.49) 1.58 (1.04–2.40)
      Perineural invasion 0.005 0.101 <0.001 <0.001
       No 1.00 (Reference) 1.00 (Reference) 1.00 (Reference) 1.00 (Reference)
       Yes 1.52 (1.14–2.02) 1.30 (0.95–1.77) 3.56 (2.41–5.26) 2.57 (1.70–3.90)
      Stage 0.011 <0.001 <0.001 <0.001
       I 1.00 (Reference) 1.00 (Reference) 1.00 (Reference) 1.00 (Reference)
       II 1.38 (0.97–1.95) 1.66 (1.16–2.39) 3.45 (1.47–8.11) 3.59 (1.47–8.75)
       III 1.73 (1.20–2.48) 2.96 (1.93–4.54) 7.47 (3.22–17.32) 7.66 (2.97–19.79)
      Adjuvant chemotherapy 0.046 <0.001 0.008 0.034
       No 1.00 (Reference) 1.00 (Reference) 1.00 (Reference) 1.00 (Reference)
       Yes 0.77 (0.60–1.00) 0.49 (0.36–0.67) 1.67 (1.15–2.48) 0.61 (0.38–0.96)
      Table 1. Demographic and clinicopathologic characteristics of the study population (n=3,313)

      Values are presented as number (%)

      aIncludes cecum, ascending colon, hepatic flexure, transverse colon. bIncludes splenic flexure, descending colon, sigmoid colon. cSignet ring cell, mucinous cell carcinoma.

      Table 2. Univariable and multivariable analyses of risk factors for recurrence-free survival (n=3,313)

      HR, hazard ratio; CI, confidence interval; NA, not applicable.

      Table 3. Univariable and multivariable analysis of risk factors for OS and RFS in colon cancer patients aged ≥70 years (n=933)

      OS, overall survival; RFS, recurrence-free survival; HR, hazard ratio; CI, confidence interval; NA, not applicable.

      Table 1.

      Table 2.

      Table 3.

      Ann Coloproctol : Annals of Coloproctology Twitter Facebook
      © Korean Society of Coloproctology.
      TOP