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Efficacy of Surgery and Adjuvant Therapy in Older Patients With Colorectal Cancer

Overview of attention for article published in Medicine (Wolters Kluwer), December 2014
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Title
Efficacy of Surgery and Adjuvant Therapy in Older Patients With Colorectal Cancer
Published in
Medicine (Wolters Kluwer), December 2014
DOI 10.1097/md.0000000000000266
Pubmed ID
Authors

Lie Yang, Qin Ma, Yong-Yang Yu, Cun Wang, Wen-Jian Meng, Gunnar Adell, Maria Albertsson, Gunnar Arbman, Ingvar Jarlsfelt, Zhi-Hai Peng, Yuan Li, Zong-Guang Zhou, Xiao-Feng Sun

Abstract

The present study aimed to assess the efficacy of surgery and adjuvant therapy in older patients (age≥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 <70 years, 162 (35%) aged 70 to 80 years, and 123 (26%) were aged ≥80 years. Of rectal cancer patients (n=554), 264 (48%) were aged <70 years, 234 (42%) aged 70 to 80 years, and 56 (10%) aged ≥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 ≥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: 1.05-2.26, 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 ≥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.

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The data shown below were compiled from readership statistics for 60 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 60 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 9 15%
Student > Bachelor 9 15%
Student > Ph. D. Student 8 13%
Researcher 7 12%
Other 5 8%
Other 6 10%
Unknown 16 27%
Readers by discipline Count As %
Medicine and Dentistry 26 43%
Biochemistry, Genetics and Molecular Biology 3 5%
Nursing and Health Professions 3 5%
Agricultural and Biological Sciences 2 3%
Computer Science 1 2%
Other 8 13%
Unknown 17 28%