Age and adjuvant chemotherapy use after surgery for stage III colon cancer
Age and adjuvant chemotherapy use after surgery for stage III colon cancer
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DOI：
10.1093/jnci/93.11.850
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发表时间：
2001-06-06
期刊：
影响因子：
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通讯作者：
Begg, CB
中科院分区：
文献类型：
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作者：
Schrag, D;Cramer, LD;Begg, CB
背景：随机试验已证实，III 期结肠癌切除术后基于 5-氟尿嘧啶的辅助化疗可将随后的死亡率降低多达 30%，然而，辅助治疗在临床试验环境之外的使用程度，特别是在老年人中，尚不清楚。方法：一项回顾性队列研究利用监测、流行病学和最终结果/医疗保险相关数据库确定了 6262 名 65 岁及以上的已切除 III 期结肠癌患者。主要结局是手术后 3 个月内化疗的使用，根据医疗保险索赔确定。我们检查了诊断时年龄与辅助化疗使用的相关程度，并根据其他患者特征的差异，使用多元逻辑回归对潜在的混杂因素进行了调整。所有 P 值都是双向的。结果：诊断时的年龄是化疗的最强决定因素：78%的65-69岁患者、74%的70-74岁患者、58%的75-79岁患者、34%的80-84岁患者和11%的85-89岁患者接受了术后化疗。根据患者人口统计学和临床特征的变化对潜在混杂因素进行调整后，并在排除任何明显合并症（高 P 值 < .001）的患者后，年龄趋势仍然明显。结论：III期结肠癌的辅助化疗被广泛使用，特别是对于75岁以下的患者，但治疗率随着实际年龄的增长而急剧下降。由于 70 多岁甚至 80 多岁的患者有合理的预期寿命，因此需要进一步努力确保老年患者有机会就这种潜在的治愈性治疗做出明智的决定。
Background: Randomized trials have established that 5-fluorouracil-based adjuvant chemotherapy following resection of stage III colon cancer reduces subsequent mortality by as much as 30%, However, the extent to which adjuvant therapy is used outside the clinical trial setting, particularly among the elderly, is unknown. Methods: A retrospective cohort study utilizing the Surveillance, Epidemiology, and End Results/Medicare-linked database identified 6262 patients aged 65 years and older with resected stage III colon cancer. The primary outcome was chemotherapy use within 3 months of surgery, as ascertained from Medicare claims. We examined the extent to which age at diagnosis was associated with adjuvant chemotherapy usage, and we adjusted for potential confounding based on differences in other patient characteristics with the use of multiple logistic regression. All P values were two-sided. Results: Age at diagnosis was the strongest determinant of chemotherapy: 78% of patients aged 65-69 years, 74% of those aged 70-74 years, 58% of those aged 75-79 years, 34% of those aged 80-84 years, and 11% of those aged 85-89 years received postoperative chemotherapy. The age trend remained pronounced after adjustment for potential confounding based on variation in patients' demographic and clinical characteristics and after exclusion of patients with any evident comorbidity tall P values < .001). Conclusions: Adjuvant chemotherapy for stage III colon cancer is used extensively, especially for patients under the age of 75 years, However, treatment rates decline dramatically with chronologic age. Because patients in their 70s and even 80s have a reasonable life expectancy, further efforts are needed to ensure that elderly patients have the opportunity to make informed decisions regarding this potentially curative treatment.