Mediating Effect of Postsurgical Chemotherapy on Presence of Dementia and Survival among Patients 65 and Older with Stage III Colon Cancer
Mediating Effect of Postsurgical Chemotherapy on Presence of Dementia and Survival among Patients 65 and Older with Stage III Colon Cancer
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DOI：
10.1158/1055-9965.epi-17-0277
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发表时间：
2017-10-01
影响因子：
3.8
通讯作者：
Beckett, Laurel
中科院分区：
文献类型：
--
作者：
Chen, Yingjia;Cress, Rosemary D.;Beckett, Laurel
引言：结肠癌和痴呆症在老年人中普遍存在，并且具有高风险的并发症。以前的研究发现，痴呆症患者的治疗不那么积极。在这项研究中，我们假设，存在的预先存在的痴呆症与生存期较差的III期结肠癌患者，术后化疗的因果pathway.Methods：我们定义了预先存在的痴呆症的监测流行病学和最终结果医疗保险数据，通过一个正式的诊断或痴呆症药物的处方或两者在诊断癌症。我们应用多变量考克斯回归来评估既存痴呆对生存率的影响，调整人口统计学因素、肿瘤特征和接受化疗。我们评估了中介效应的背景下，反事实的框架，使用加速故障时间model.Results：有4,573例患者诊断为III期结肠癌在2007年和2009年之间确定。先前诊断为痴呆的患者死亡风险显著增加45%（HR = 1.45，95% CI：1.29-1.63）。与认知健康的患者相比，正式诊断为痴呆或相关处方的患者的病因特异性生存率显着降低。接受化疗是一个显着的中介的因果关系的途径。存在痴呆的影响是通过接受化疗介导的13%的预先存在的dementia.Conclusions：预先存在的痴呆与III期结肠癌患者的生存率降低显著相关，其有害影响部分解释为术后接受化疗的可能性降低。这是第一项评估减少化疗对III期结肠癌和痴呆患者的介导作用的研究，同时证明了在痴呆存在下化疗的癌症特异性生存益处。癌症流行病学生物标志物Prev; 26（10）; 155863。(C)2017年AACR。
Introduction: Both colon cancer and dementia are prevalent among the elderly and have a high risk of cooccurrence. Previous studies found that patients with dementia were treated less aggressively. In this study, we hypothesized that presence of preexisting dementia was associated with worse survival for stage III colon cancer patients, and that postoperative chemotherapy was on the causal pathway.Methods: We defined preexisting dementia in Surveillance Epidemiology and End Results Medicare data through either a formal diagnosis or a prescription for dementia drugs or both before the diagnosis of cancer. We applied multivariable Cox regression to estimate the effect of preexisting dementia on survival, adjusting for demographic factors, tumor characteristics, and receipt of chemotherapy. We assessed mediating effects in the context of the counterfactual framework using the accelerated failure time model.Results: There were 4,573 patients diagnosed with stage III colon cancer between 2007 and 2009 identified. A preexisting diagnosis of dementia significantly increased the risk of death by 45% (HR = 1.45, 95% CI: 1.29-1.63). Patients with either a formal diagnosis of dementia or a related prescription had significantly lower cause-specific survival than their cognitively healthy counterparts. Receipt of chemotherapy was a significant mediator on the causal pathway. The effect of presence of dementia was mediated by receipt of chemotherapy by 13% for preexisting dementia.Conclusions: Preexisting dementia is significantly associated with worse survival for stage III colon cancer patients, and its deleterious effect is partially explained by decreased likelihood of postoperative chemotherapy receipt.Impact: This is the first study that provides estimate of the mediating effect of diminished chemotherapy in patients with stage III colon cancer and dementia, simultaneously demonstrating the cancer-specific survival benefit of chemotherapy in the presence of dementia. Cancer Epidemiol Biomarkers Prev; 26(10); 155863. (C) 2017 AACR.