Are we undertreating rectal cancer in the elderly? An epidemiologic study
Are we undertreating rectal cancer in the elderly? An epidemiologic study
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DOI：
10.1097/sla.0b013e318070838f
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发表时间：
2007-08-01
影响因子：
9
通讯作者：
Rodriguez-Bigas, Miguel
中科院分区：
文献类型：
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作者：
Chang, George J.;Skibber, John M.;Rodriguez-Bigas, Miguel
目的：为了更好地了解老年直肠癌患者生存率下降的原因，通过流行病学评估年龄相关的治疗和survival.Summary背景数据的差异：直肠癌的发病率随着年龄的增长而增加，局部疾病可以治愈性治疗分期适当的根治性手术。然而，老年患者已注意到经验减少survival.Methods：局部直肠腺癌患者被确定在监测，流行病学和最终结果数据库（1991-2002）。通过单变量和多变量回归分析，评估了年龄、性别、手术类型、肿瘤分级、淋巴结状态和放射治疗的使用情况等癌症特异性生存率。中位年龄为68岁。年龄≥ 70岁的每增加5年，癌症相关死亡率的相对风险（RR）增加37（RR = 1.37; 95%置信区间[CI]，1.33-1.42）;减少接受癌症导向手术（比值比[OR] = 0.56; 95% CI，0.36-0.63）;更多局部切除，更少根治性手术（OR = 0.76; 95% CI，0.72-0.81）、放疗次数少（OR = 0.64; 95% CI，0.61-0.67）、NO病理分期可能性大（OR = 1.10; 95% CI，1.05-1.15）（各因素P < 0.0001）。在多变量分析中，年龄对癌症特异性死亡率的影响持续存在，年龄≥ 70岁每增加5年，癌症特异性死亡率增加31（RR = 1.31; 95%CI，1.25-1.36; P < 0.0001）。在老年患者中，直肠癌的特征是癌症相关生存率降低，这与总体治疗积极性降低和疾病分期减少有关。调查这些治疗差异的原因可能有助于确定改善癌症结局的干预措施。
Objective: To better understand the reasons for decreased survival rates in elderly patients with rectal cancer by performing an epidemiologic evaluation of age-related differences in treatment and survival.Summary Background Data: The incidence of rectal cancer increases with older age, and localized disease can be curatively treated with stage-appropriate radical surgery. However, older patients have been noted to experience decreased survival.Methods: Patients with localized rectal adenocarcinoma were identified in the Surveillance, Epidemiology, and End Results database (1991-2002). Cancer-specific survival by age, sex, surgery type, tumor grade, lymph node status, and use of radiation therapy was evaluated using univariate and multivariate regression analysis.Results: We identified 21,390 patients who met the selection criteria. The median age was 68 years. Each half-decade increase in age >= 70 years was associated with a 37% increase in the relative risk (RR) for cancer-related mortality (RR = 1.37; 95% confidence interval [CI], 1.33-1.42); decreased receipt of cancer-directed surgery (odds ratio [OR] = 0.56; 95% CI, 0.36-0.63); more local excision and less radical surgery (OR = 0.76; 95% CI, 0.72-0.81); less radiotherapy (OR = 0.64; 95% CI, 0.61-0.67); and greater likelihood of NO pathologic stage classification (OR = 1.10; 95% CI, 1.05-1.15) (P < 0.0001 for each factor). The effect of age on cancer-specific mortality persisted in multivariate analysis with each half-decade increase in age >= 70 years resulting in a 31% increase in cancer-specific mortality (RR = 1.31; 95% CI, 1.25-1.36; P < 0.0001).Conclusions: In elderly patients, rectal cancer is characterized by decreased cancer-related survival rates that are associated with less aggressive treatment overall and decreased disease stages at presentation. Investigation into the reasons for these treatment differences may help to define interventions to improve cancer outcomes.