Efficacy and toxicity of adjuvant chemotherapy in elderly patients with colorectal cancer: the ACCORE study.
Efficacy and toxicity of adjuvant chemotherapy in elderly patients with colorectal cancer: the ACCORE study.
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DOI：
10.1136/esmoopen-2016-000087
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发表时间：
2016
期刊：
影响因子：
7.3
通讯作者：
Vistisen KK
中科院分区：
文献类型：
--
作者：
Lund CM;Nielsen D;Dehlendorff C;Christiansen AB;Rønholt F;Johansen JS;Vistisen KK
由于担心毒性和疗效，老年原发性结直肠癌 (CRC) 患者接受辅助化疗的频率低于年轻患者。我们调查了年龄、体能状态 (PS) 和合并症如何影响治疗结果。一项回顾性单中心研究，纳入 2001 年至 2011 年在丹麦 Herlev 医院接受辅助化疗（5-氟尿嘧啶/卡培他滨+/÷奥沙利铂）的 529 名 II-III 期 CRC 患者。调整 PS 和合并症后，根据年龄分析基线特征、化疗和结果。与年轻患者相比，老年患者（> 70岁）的合并症明显更多（p<0.001），PS也更差（p=0.001）。老年人更常接受单药治疗（p=0.001）且初始剂量较低（p<0.001）。 3 年无病生存率（DFS；HR 1.09，95% CI 0.80 至 1.47，p=0.59）、3-5 级毒性（29% vs 28%，p=0.86）或 10 年 CRC 死亡率（28%，HR 1.07，p=0.71）不存在年龄依赖性差异。在老年患者中，与全剂量相比，化疗剂量强度的降低对 DFS 或 CRC 死亡率没有影响。与接受所有周期的老年人相比，接受<50%计划周期的老年患者的 DFS 更短（HR=1.78，p=0.020），CRC 死亡率更高（HR=2.17，p=0.027）。年轻和老年患者的 PS 较差与较短的 DFS（分别为 HR=1.95，p=0.002；HR=1.6，p=0.035）和总生存期（OS；HR=2.28，p<0.001；HR=2.03，p=0.002）相关。年轻患者的合并症与较短的 DFS（HR 2.72，p<0.001）、OS（HR 3.16，p<0.001）和较高的 CRC 死亡率（HR 2.70，p=0.001）显着相关。 CRC 辅助化疗患者的治疗方案选择、主要剂量减少和剂量强度高度依赖于年龄。然而，年龄对 DFS 和 CRC 死亡率没有影响。年轻患者的合并症和所有患者的 PS 与较短的 DFS 和较高的 CRC 死亡率相关。
Elderly patients with primary colorectal cancer (CRC) are less frequently treated with adjuvant chemotherapy than younger patients due to concerns regarding toxicity and efficiency. We investigated how age, performance status (PS) and comorbidity influence treatment outcomes. A retrospective single-centre study of 529 patients with stages II–III CRC treated with adjuvant chemotherapy (5-fluorouracil/capecitabine+/÷oxaliplatin) from 2001 to 2011 at Herlev Hospital, Denmark. Baseline characteristics, chemotherapy and outcome were analysed with respect to age after adjusting for PS and comorbidity. Elderly patients (>70 years) had significantly more comorbidity (p<0.001) and poorer PS (p=0.001) than younger patients. Elderly were more frequently treated with single-agent therapy (p=0.001) and at lower initial dose (p<0.001). There was no age-dependent difference in 3-year disease-free survival (DFS; HR 1.09, 95% CI 0.80 to 1.47, p=0.59), in grade 3–5 toxicity (29% vs 28%, p=0.86) or in 10-year CRC mortality (28%, HR 1.07, p=0.71). In elderly patients, a reduction in chemotherapy dose intensity compared with full dose had no impact on DFS or CRC mortality. Elderly patients receiving <50% of planned cycles had shorter DFS (HR=1.78, p=0.020) and higher CRC mortality (HR=2.17, p=0.027) than elderly receiving all cycles. Poor PS in younger and elderly patients was related to shorter DFS (HR=1.95, p=0.002; HR=1.6, p=0.035, respectively) and overall survival (OS; HR=2.28, p<0.001; HR=2.03, p=0.002). Comorbidity in younger patients was significantly related to shorter DFS (HR 2.72, p<0.001), OS (HR 3.16, p<0.001) and higher CRC mortality (HR 2.70, p=0.001). Choice of regimen, primary dose reduction and given dose intensity in patients treated with adjuvant chemotherapy for CRC were highly dependent on age. However, age had no impact on DFS and CRC mortality. Comorbidity in younger patients and PS in all patients were associated with shorter DFS and higher CRC mortality.