Impact of Age and Comorbidity on Multimodal Management and Survival from Colorectal Cancer: A Population-Based Study.
Impact of Age and Comorbidity on Multimodal Management and Survival from Colorectal Cancer: A Population-Based Study.
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DOI：
10.3390/jcm10081751
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发表时间：
2021-04-17
影响因子：
3.9
通讯作者：
Seppälä TT
中科院分区：
文献类型：
--
作者：
Kellokumpu I;Kairaluoma M;Mecklin JP;Kellokumpu H;Väyrynen V;Wirta EV;Sihvo E;Kuopio T;Seppälä TT
这项基于人群的回顾性研究探讨了年龄和合并症负担对结直肠癌 (CRC) 多模式治疗和生存的影响。从 2000 年到 2015 年，连续 1479 名接受 CRC 手术切除的患者接受了年龄调整的查尔森合并症指数 (ACCI) 评估，其中包括 19 种明确的加权合并症。比较低 ACCI（分数 0-2）、中（分数 3）和高 ACCI（分数 ≥ 4）组之间 ACCI 对多模式管理和生存的影响。从 2000 年到 2015 年，治疗方法发生了变化，腹腔镜手术大幅增加、辅助化疗的使用增加以及转移性疾病的强化治疗。根据定义，ACCI 评分高的患者年龄较大且合并症较高。 ACCI 组之间对结肠癌的主要选择性和紧急切除术以及腹腔镜和开腹切除术的实施情况相当。在高 ACCI 组中，直肠癌的（化学）放射治疗较少使用，局部切除率较高，因此主要选择性切除率较低。 ACCI 高组中辅助化疗和转移灶切除术的使用频率较低。随着时间的推移，I-III 期 CRC 的总体生存率和癌症特异性生存率保持稳定，但 IV 期的生存率有所改善。然而，与低 ACCI 组相比，高 ACCI 组的 I-IV 期结肠癌和直肠癌的 5 年总体生存率较差。根据 ACCI 的结果，五年癌症特异性生存率和无病生存率没有显着差异。 Cox 比例风险分析表明，高 ACCI 是总体生存率较差的独立预测因子 (p < 0.001)。我们的结果表明，尽管随着时间的推移，多模式管理有所改善，但高龄和高合并症负担影响了辅助化疗、术前（化疗）放疗和转移性疾病的治疗的使用，并恶化了 CRC 的总体生存率。
This retrospective population-based study examined the impact of age and comorbidity burden on multimodal management and survival from colorectal cancer (CRC). From 2000 to 2015, 1479 consecutive patients, who underwent surgical resection for CRC, were reviewed for age-adjusted Charlson comorbidity index (ACCI) including 19 well-defined weighted comorbidities. The impact of ACCI on multimodal management and survival was compared between low (score 0–2), intermediate (score 3) and high ACCI (score ≥ 4) groups. Changes in treatment from 2000 to 2015 were seen next to a major increase of laparoscopic surgery, increased use of adjuvant chemotherapy and an intensified treatment of metastatic disease. Patients with a high ACCI score were, by definition, older and had higher comorbidity. Major elective and emergency resections for colon carcinoma were evenly performed between the ACCI groups, as were laparoscopic and open resections. (Chemo)radiotherapy for rectal carcinoma was less frequently used, and a higher rate of local excisions, and consequently lower rate of major elective resections, was performed in the high ACCI group. Adjuvant chemotherapy and metastasectomy were less frequently used in the ACCI high group. Overall and cancer-specific survival from stage I-III CRC remained stable over time, but survival from stage IV improved. However, the 5-year overall survival from stage I–IV colon and rectal carcinoma was worse in the high ACCI group compared to the low ACCI group. Five-year cancer-specific and disease-free survival rates did not differ significantly by the ACCI. Cox proportional hazard analysis showed that high ACCI was an independent predictor of poor overall survival (p < 0.001). Our results show that despite improvements in multimodal management over time, old age and high comorbidity burden affect the use of adjuvant chemotherapy, preoperative (chemo)radiotherapy and management of metastatic disease, and worsen overall survival from CRC.
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影响因子：
8.8
作者：
Jorgensen, T. L.;Hallas, J.;Friis, S.;Herrstedt, J.
通讯作者：
Herrstedt, J.
影响因子：
3.9
作者：
Ostenfeld EB;Nørgaard M;Thomsen RW;Iversen LH;Jacobsen JB;Søgaard M
通讯作者：
Søgaard M
影响因子：
3.8
作者：
Dias-Santos, Daniela;Ferrone, Cristina R.;Fernandez-del Castillo, Carlos
通讯作者：
Fernandez-del Castillo, Carlos
影响因子：
--
作者：
Alves, A;Panis, Y;Slim, K
通讯作者：
Slim, K
影响因子：
8.4
作者：
Faivre, J.;Lemmens, V. E. P. P.;Bouvier, A. M.
通讯作者：
Bouvier, A. M.