Background:The US Preventive Services Task Force of Colorectal Cancer (USPSTF) recommends against continuing screening for colorectal cancer (CRC) past 75 years in adequately screened individuals.Survival and staging data for CRC that compares elderly vs. younger populations has not been published.This study aims to compare staging (0-4) of CRC in groups of 60-69, 70-79 and 80-89-year-old; also, to compare surgical and no treatment (i.e., no surgery) survival outcomes (5-10 years) in these age groups. Methods: Male veterans within groups 60-69, 70-79 and 80-89 years of age who were diagnosed with CRC between 2000 and 2015 were selected from Veterans affairs national cancer cube registry. Results: Their staging, surgery or no treatment, and 5-10 years survival data was obtained from the cancer cube. Surgical and survival data was obtained only for stage 0-2 as surgery is currently the standard of treatment for these stages. Conclusions: Highest number of CRC cases diagnosed across each age group was stage 1 with stage 2 being second. In surgical treatment group the survival was statistical different for 80-89 age group as compared to 60-69 (34.4%) and 70-79 (30.86%) although octogenarians did have a surprisingly high mean of 25.45%. The 5-10-year survival data for no treatment group (i.e., no surgery) was very poor.
Background
According to Surveillance, Epidemiology and End Results (SEER) database, colorectal cancer (CRC) is the fourth most common type of cancer and second highest in cancer-related death after lung cancer. The SEER database is geographically limited, currently present in only 10–12 states. Though this gives a good approximation about the overall direction of CRC incidence and prevalence, we need more nationwide data to compare numbers. Furthermore, colonoscopies and CRC rates in the Veterans Affair (VA) geriatric population have not been studied.
Objectives and methods
Our aim was to study the rate of colonoscopies and CRC in octogenarians and nonagenarians and to find the prevalence of CRC in this population. The goal was to obtain data in this subset of patients in order to further expand CRC screening guidelines. A retrospective data analysis was performed consisting of US male veterans who underwent colonoscopy in the VA Health Care System from 2000 to 2015.
Results and conclusion
A total of 458,224 patients aged ≥80 years were identified from the database between years 2000 and 2015. This was divided into three groups of age 80–84 years (89,621 patients), 85–90 years (248,155 patients), and >90 years (120,448 patients). A total of 81,946 patients underwent colonoscopies of which 9,365 were diagnosed with CRC. There was a statistically significant linear increase in rate of colonoscopies with increase in age suggesting that these veterans who end up living to a higher age eventually get a colonoscopy for one reason or the other. The drop in CRC percentage and prevalence observed in age group 85–90 years is statistically different when compared to that in 80–84 years and >90 years groups; however, its clinical significance remains to be elucidated.
Epidermal growth factor receptor (EGFR) has been an attractive target for treatment of epithelial cancers, including colorectal cancer (CRC). Evidence from clinical trials indicates that cetuximab and panitumumab (anti-EGFR monoclonal antibodies) have clinical activity in patients with metastatic CRC. The discovery of intrinsic EGFR blockade resistance in Kirsten RAS (KRAS)-mutant patients led to the restriction of anti-EGFR antibodies to KRAS wild-type patients by Food and Drug Administration and European Medicine Agency. Studies have since focused on the evaluation of biomarkers to identify appropriate patient populations that may benefit from EGFR blockade. Accumulating evidence suggests that patients with mutations in EGFR downstream signaling pathways including KRAS, BRAF, PIK3CA and PTEN could be intrinsically resistant to EGFR blockade. Recent whole genome studies also suggest that dynamic alterations in signaling pathways downstream of EGFR leads to distinct oncogenic signatures and subclones which might have some impact on emerging resistance in KRAS wild-type patients. While anti-EGFR monoclonal antibodies have a clear potential in the management of a subset of patients with metastatic CRC, further studies are warranted to uncover exact mechanisms related to acquired resistance to EGFR blockade.
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