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, I. Takemasa, K. Hakamada, H. Kameyama, Y. Takii, K. Hase, K. Kotake, T. Watanabe, K. Takahashi, Y. Kanemitsu & 12 others M. Itabashi, H. Yano, M. Yasuno, H. Hasegawa, Y. Hashiguchi, T. Masaki, M. Watanabe, K. Maeda, K. Komori, Y. Sakai, M. Ohue, Y. Akagi

Research output: Contribution to journalArticle

8 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)90-101
Number of pages12
JournalEuropean Journal of Cancer
Volume81
DOIs
Publication statusPublished - 2017 Aug 1

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Adjuvant Chemotherapy
Multicenter Studies
Comorbidity
Colorectal Neoplasms
Retrospective Studies
Survival
Rectal Neoplasms
Tumor Biomarkers
Colonic Neoplasms
Therapeutics
Carcinoembryonic Antigen
Age Groups

Keywords

  • 75 years
  • Adjuvant chemotherapy
  • Charlson score
  • Colorectal cancer
  • Comorbidity
  • Elderly patients
  • Prognosis

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Influence of age and comorbidity on prognosis and application of adjuvant chemotherapy in elderly Japanese patients with colorectal cancer : A retrospective multicentre study. / Yamano, Tomoki; Yamauchi, Shinichi; Kimura, Kei; Babaya, Akihito; Hamanaka, Michiko; Kobayashi, Masayoshi; Fukumoto, Miki; Tsukamoto, Kiyoshi; Noda, Masafumi; Tomita, Naohiro; Sugihara, Kenichi; Takemasa, I.; Hakamada, K.; Kameyama, H.; Takii, Y.; Hase, K.; Kotake, K.; Watanabe, T.; Takahashi, K.; Kanemitsu, Y.; Itabashi, M.; Yano, H.; Yasuno, M.; Hasegawa, H.; Hashiguchi, Y.; Masaki, T.; Watanabe, M.; Maeda, K.; Komori, K.; Sakai, Y.; Ohue, M.; Akagi, Y.

In: European Journal of Cancer, Vol. 81, 01.08.2017, p. 90-101.

Research output: Contribution to journalArticle

Yamano, T, Yamauchi, S, Kimura, K, Babaya, A, Hamanaka, M, Kobayashi, M, Fukumoto, M, Tsukamoto, K, Noda, M, Tomita, N, Sugihara, K, Takemasa, I, Hakamada, K, Kameyama, H, Takii, Y, Hase, K, Kotake, K, Watanabe, T, Takahashi, K, Kanemitsu, Y, Itabashi, M, Yano, H, Yasuno, M, Hasegawa, H, Hashiguchi, Y, Masaki, T, Watanabe, M, Maeda, K, Komori, K, Sakai, Y, Ohue, M & Akagi, Y 2017, 'Influence of age and comorbidity on prognosis and application of adjuvant chemotherapy in elderly Japanese patients with colorectal cancer: A retrospective multicentre study', European Journal of Cancer, vol. 81, pp. 90-101. https://doi.org/10.1016/j.ejca.2017.05.024
Yamano, Tomoki ; Yamauchi, Shinichi ; Kimura, Kei ; Babaya, Akihito ; Hamanaka, Michiko ; Kobayashi, Masayoshi ; Fukumoto, Miki ; Tsukamoto, Kiyoshi ; Noda, Masafumi ; Tomita, Naohiro ; Sugihara, Kenichi ; Takemasa, I. ; Hakamada, K. ; Kameyama, H. ; Takii, Y. ; Hase, K. ; Kotake, K. ; Watanabe, T. ; Takahashi, K. ; Kanemitsu, Y. ; Itabashi, M. ; Yano, H. ; Yasuno, M. ; Hasegawa, H. ; Hashiguchi, Y. ; Masaki, T. ; Watanabe, M. ; Maeda, K. ; Komori, K. ; Sakai, Y. ; Ohue, M. ; Akagi, Y. / Influence of age and comorbidity on prognosis and application of adjuvant chemotherapy in elderly Japanese patients with colorectal cancer : A retrospective multicentre study. In: European Journal of Cancer. 2017 ; Vol. 81. pp. 90-101.
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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.",
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T1 - Influence of age and comorbidity on prognosis and application of adjuvant chemotherapy in elderly Japanese patients with colorectal cancer

T2 - A retrospective multicentre study

AU - Yamano, Tomoki

AU - Yamauchi, Shinichi

AU - Kimura, Kei

AU - Babaya, Akihito

AU - Hamanaka, Michiko

AU - Kobayashi, Masayoshi

AU - Fukumoto, Miki

AU - Tsukamoto, Kiyoshi

AU - Noda, Masafumi

AU - Tomita, Naohiro

AU - Sugihara, Kenichi

AU - Takemasa, I.

AU - Hakamada, K.

AU - Kameyama, H.

AU - Takii, Y.

AU - Hase, K.

AU - Kotake, K.

AU - Watanabe, T.

AU - Takahashi, K.

AU - Kanemitsu, Y.

AU - Itabashi, M.

AU - Yano, H.

AU - Yasuno, M.

AU - Hasegawa, H.

AU - Hashiguchi, Y.

AU - Masaki, T.

AU - Watanabe, M.

AU - Maeda, K.

AU - Komori, K.

AU - Sakai, Y.

AU - Ohue, M.

AU - Akagi, Y.

PY - 2017/8/1

Y1 - 2017/8/1

N2 - 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.

AB - 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.

KW - 75 years

KW - Adjuvant chemotherapy

KW - Charlson score

KW - Colorectal cancer

KW - Comorbidity

KW - Elderly patients

KW - Prognosis

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