Influence of age and comorbidity on prognosis and application of adjuvant chemotherapy in elderly Japanese patients with colorectal cancer: A retrospective multicentre study

Tomoki Yamano; Shinichi Yamauchi; Kei Kimura; Akihito Babaya; Michiko Hamanaka; Masayoshi Kobayashi; Miki Fukumoto; Kiyoshi Tsukamoto; Masafumi Noda; Naohiro Tomita; Kenichi Sugihara; Japanese Study Group for Postoperative Follow-up of Colorectal Cancer

doi:10.1016/j.ejca.2017.05.024

Influence of age and comorbidity on prognosis and application of adjuvant chemotherapy in elderly Japanese patients with colorectal cancer: A retrospective multicentre study

Eur J Cancer. 2017 Aug:81:90-101. doi: 10.1016/j.ejca.2017.05.024. Epub 2017 Jun 13.

Collaborators

Japanese Study Group for Postoperative Follow-up of Colorectal Cancer:
I Takemasa¹², K Hakamada¹³, H Kameyama¹⁴, Y Takii¹⁵, K Hase¹⁶, K Kotake¹⁷, T Watanabe¹⁸, K Takahashi¹⁹, Y Kanemitsu²⁰, M Itabashi²¹, H Yano²², M Yasuno²³, H Hasegawa²⁴, Y Hashiguchi²⁵, T Masaki²⁶, M Watanabe²⁷, K Maeda²⁸, K Komori²⁹, Y Sakai³⁰, M Ohue³¹, Y Akagi³²

Affiliations

¹ Division of Lower GI Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan. Electronic address: yamanot@hyo-med.ac.jp.
² Division of Colorectal Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: s-yamauchi.srg2@tmd.ac.jp.
³ Division of Lower GI Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan. Electronic address: k-kimura@hyo-med.ac.jp.
⁴ Division of Lower GI Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan. Electronic address: bababa7@hyo-med.ac.jp.
⁵ Division of Lower GI Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan. Electronic address: michiko_hamanaka1023@yahoo.co.jp.
⁶ Division of Lower GI Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan. Electronic address: oz86.kurumi@gmail.com.
⁷ Division of Lower GI Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan. Electronic address: mi-fukumoto@hyo-med.ac.jp.
⁸ Division of Lower GI Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan. Electronic address: tsuka25@hyo-med.ac.jp.
⁹ Division of Lower GI Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan. Electronic address: noda2s@hyo-med.ac.jp.
¹⁰ Division of Lower GI Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan. Electronic address: ntomita@hyo-med.ac.jp.
¹¹ Division of Colorectal Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: k-sugi.srg2@tmd.ac.jp.
¹² Sapporo Medical University, Japan.
¹³ Hirosaki University, Japan.
¹⁴ Niigata University, Japan.
¹⁵ Niigata Cancer Center Hospital, Japan.
¹⁶ National Defense Medical College, Japan.
¹⁷ Tochigi Cancer Center, Japan.
¹⁸ Tokyo University, Japan.
¹⁹ Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan.
²⁰ National Cancer Center Hospital, Japan.
²¹ Tokyo Women's Medical University, Japan.
²² National Center for Global Health and Medicine, Japan.
²³ Tokyo Medical and Dental University, Japan.
²⁴ Keio University, Japan.
²⁵ Teikyo University, Japan.
²⁶ Kyorin University, Japan.
²⁷ Kitasato University, Japan.
²⁸ Fujita Health University, Japan.
²⁹ Aichi Cancer Center Hospital, Japan.
³⁰ Kyoto University, Japan.
³¹ Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan.
³² Kurume University, Japan.

PMID: 28622612
DOI: 10.1016/j.ejca.2017.05.024

Abstract

Background: Adjuvant therapy for colorectal cancer (CRC) in patients aged ≥75 years is supported by inadequate evidence, although such patients are increasing in number worldwide.

Patients and methods: We assessed the influence of age and comorbidities on the prognosis of CRC in elderly patients using pooled data by the Japanese Study Group for Postoperative Follow-up of Colorectal Cancer. In total, 4598 patients (3304 with colon cancer and 1294 with rectal cancer) who underwent curative surgery from 2004 to 2006 were analysed with respect to age, Charlson comorbidity score (CS), tumour marker positivity, adjuvant therapy and prognosis.

Results: The number of patients aged <64, 65-74 and >75 years was 2007 (44%), 1614 (35%) and 977 (21%), respectively. Tumour location, tumour marker positivity, clinical stage, performance of adjuvant therapy, CS and overall survival (OS) were significantly different among these age groups (P < 0.0001). Among patients aged ≥75 years with stage III CRC, 35% with colon cancer and 21% with rectal cancer received adjuvant therapy; these proportions were much lower than those in younger patients. Application of adjuvant therapy was dependent on the CS in patients aged ≤74 years, but not in older patients. Sex, the carcinoembryonic antigen concentration and adjuvant therapy were significantly associated with OS in elderly patients with stage III CRC.

Conclusion: Age and comorbidities worsened the OS of patients with CRC who underwent curative surgery. However, patients aged ≥75 years were undertreated regardless of their CS despite the possibility of OS improvement by adjuvant therapy.

Keywords: 75 years; Adjuvant chemotherapy; Charlson score; Colorectal cancer; Comorbidity; Elderly patients; Prognosis.

Publication types

Multicenter Study

MeSH terms

Adult
Age Factors
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
Chemotherapy, Adjuvant
Colorectal Neoplasms / drug therapy*
Colorectal Neoplasms / mortality
Combined Modality Therapy
Comorbidity
Female
Humans
Japan / epidemiology
Male
Middle Aged
Prognosis
Retrospective Studies
Survival Analysis