Differences in prognosis and underuse of adjuvant chemotherapy between elderly and non‐elderly patients in stage III colorectal cancer

Abstract

Aim We aimed to clarify the use of adjuvant chemotherapy and the prognosis of elderly colorectal cancer patients compared with non‐elderly patients, and the usefulness of sarcopenia as an indicator for the introduction and completion of adjuvant chemotherapy. Methods Between 2013 and 2021, 215 patients with pStage III disease were included. We investigated perioperative clinicopathological factors, adjuvant chemotherapy details, and prognosis. Preoperative sarcopenia status was evaluated using computed tomography images. Elderly patients were defined as those aged ≥70 years. Results We included 121 (56.3%) and 94 (43.7%) non‐elderly and elderly patients, respectively. Among the elderly patients, 47 had sarcopenia. There were no significant differences in the incompletion rate of adjuvant chemotherapy between elderly and non‐elderly patients (27.1%/16.2%, P = 0.119). The most common reason for the discontinuation of adjuvant chemotherapy was side effects, regardless of age. The respective 3‐year‐disease free survival of patients with no/completed/incomplete adjuvant chemotherapy were 65.5%, 80.2%, and 57.7% for non‐elderly patients (P = 0.045) and 73.4%, 70.6%, and 71.6% for elderly patients (P = 0.924). The number of elderly patients with sarcopenia was significantly higher in patients without adjuvant chemotherapy (P = 0.004) and those with incomplete adjuvant chemotherapy (P = 0.004). The 3‐year‐disease free survival of elderly sarcopenic patients without and with adjuvant chemotherapy were 78.3% and 59.2%, respectively (P = 0.833). Conclusion Elderly patients did not show a benefit of adjuvant chemotherapy regardless of whether they had completed adjuvant chemotherapy, unlike non‐elderly patients. Moreover, the evaluation of preoperative sarcopenia in elderly colorectal cancer patients may be useful in determining the indication for adjuvant chemotherapy.

The association of body composition on chemotherapy toxicities in non‐metastatic colorectal cancer patients: a systematic review

“…9,10,12 In addition to FOLFOX, the remaining studies also examined other single-agent or multi-agent chemotherapy regimens that include fluoropyrimidine (capecitabine or 5FU) alone, fluoropyrimidine plus oxaliplatin and non-oxaliplatin-based regimens such as FOLFIRI (folinic acid, 5FU and irinotecan). 11,13,15 Chemotherapy toxicities Chemotherapy toxicity was measured in four studies. 10,12,13,15 Dose-limiting toxicity (DLT) included dose reduction, dose delay, regimen change, treatment discontinuation and incidences of hospitalization were noted in five of the six studies.…”

“…10,12,13,15 Dose-limiting toxicity (DLT) included dose reduction, dose delay, regimen change, treatment discontinuation and incidences of hospitalization were noted in five of the six studies. [9][10][11]13,15 For the four studies that focused on chemotherapy toxicities, the types of toxicities that were recorded included haemotoxicity (neutropenia, thrombocytopenia, anaemia), gastrointestinal toxicity (nausea, vomiting, diarrhoea), neurotoxicity (neuropathy), liver impairment and mucositis. Two of the four studies graded toxicities using the Common Terminology Criteria for Adverse Events (CTCAE) with a particular interest in grade 2 toxicities and above.…”

“…This was done at the third lumbar level (L3) in four studies. [9][10][11]15 A further study chose the fourth lumbar level (L4), 12 and the final study utilized the slice located within the intervertebral disc space between L3 and L4, representing the umbilical level. 13 Skeletal muscle mass assessment and sarcopenia cut-off Four of the six studies measured skeletal muscle mass.…”

“…13 Skeletal muscle mass assessment and sarcopenia cut-off Four of the six studies measured skeletal muscle mass. [10][11][12]15 Cespedes Feliciano et al and Looijaard et al both measured the 2D total skeletal muscle area (SMA). 10,15 In addition, Looijaard et al divided SMA by each individual's height squared to obtain the skeletal muscle index (SMI) to normalize for height variations.…”

“…[6][7][8] Growing evidence suggests variations in body composition could affect chemotherapy dosing, contributing to the development of such toxicities, and support the measurement of both skeletal muscle and adiposity to refine current chemotherapy dosing techniques better. [6][7][8][9][10][11][12][13][14] This systematic review aims to analyse the available evidence on the correlation between body composition, which includes skeletal muscle mass, subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), intramuscular adiposity, intermuscular adiposity, and the association with the occurrence of chemotherapy-related toxicities in patients with non-metastatic colorectal cancer. By analysing this evidence, we seek to gain insights into the potential relationship between body composition and the development of chemotherapy toxicities in this specific patient population.…”