Prediction of overall survival following colorectal cancer surgery in elderly patients

Abstract

BACKGROUND With advanced age and chronic illness, the life expectancy of a patient with colorectal cancer (CRC) becomes less dependent on the malignant disease and more on their pre-morbid condition. Justifying major surgery for these elderly patients can be challenging. An accurate tool demonstrating post-operative survival probability would be useful for surgeons and their patients. AIM To integrate clinically significant prognostic factors relevant to elective colorectal surgery in the elderly into a validated pre-operative scoring system. METHODS In this retrospective cohort study, patients aged 70 and above who underwent surgery for CRC at Singapore General Hospital between 1 January 2005 and 31 December 2012 were identified from a prospectively maintained database. Patients with evidence of metastatic disease, and those who underwent emergency surgery or had surgery for benign colorectal conditions were excluded from the analysis. The primary outcome was overall 3-year overall survival (OS) following surgery. A multivariate model predicting survival was derived and validated against an equivalent external surgical cohort from Kyungpook National University Chilgok Hospital, South Korea. Statistical analyses were performed using Stata/MP Version 15.1. RESULTS A total of 1267 patients were identified for analysis. The median post-operative length of stay was 8 [interquartile range (IQR) 6-12] d and median follow-up duration was 47 (IQR 19-75) mo. Median OS was 78 (IQR 65-85) mo. Following multivariate analysis, the factors significant for predicting overall mortality were serum albumin < 35 g/dL, serum carcinoembryonic antigen ≥ 20 µg/L, T stage 3 or 4, moderate tumor cell differentiation or worse, mucinous histology, rectal tumors, and pre-existing chronic obstructive lung disease. Advanced age alone was not found to be significant. The Korean cohort consisted of 910 patients. The Singapore cohort exhibited a poorer OS, likely due to a higher proportion of advanced cancers. Despite the clinicopathologic differences, there was successful validation of the model following recalibration. An interactive online calculator was designed to facilitate post-operative survival prediction, available at http://bit.ly/sgh_crc. The main limitation of the study was selection bias, as patients who had undergone surgery would have tended to be physiologically fitter. CONCLUSION This novel scoring system generates an individualized survival probability following colorectal resection and can assist in the decision-making process. Validation with an external population strengthens the generalizability of this model.

A Theory-Based, Multidisciplinary Approach to Cocreate a Patient-Centric Digital Solution to Enhance Perioperative Health Outcomes Among Colorectal Cancer Patients and Their Family Caregivers: Development and Evaluation Study

“…Access to psychosocial support is limited and confined to those deemed to be at risk of significant psychological morbidity. This affects up to approximately 160 patients, who undergo elective colorectal resections annually in 1 local health care institution alone [ 25 ], and aggravates the mental distress already prevalent within this population [ 26 ]. Moreover, a preliminary study found great appetite for easily retrievable, in-depth, credible information about treatment and interest in the use of health technologies with embedded multimedia [ 27 ].…”

The safety and prognosis of radical surgery in colorectal cancer patients over 80 years old

“…In addition, these individuals often have comorbidities such as cardiovascular and cerebrovascular diseases and diabetes and often need more rigorous and prudent standardized management during the perioperative period [ 6 ]. According to the clinical consensus and guidelines, adjuvant treatment such as chemotherapy and radiotherapy is not recommended for CRC patients older than 80 years of age regardless of TNM stage, but traditional prognostic indicators may not be suitable for elderly patients with CRC over 80 years old [ 8 – 15 ]. Therefore, the main purpose of the present study was to demonstrate the safety and feasibility of radical surgery for CRC in elderly patients over 80 years of age, to evaluate the prognosis of elderly CRC patients without adjuvant therapy using the tumour-specific survival rate, and to comprehensively explore relevant prognostic factors.…”

The Effect of Body Mass Index on the Feasibility of Surgery and Prognosis of Colorectal Cancer Patients Over 80 Years Old

“…The safety of radical surgery for elderly patients with colorectal cancer is a concern for surgeons. Prior works have reported that the incidence of overall complications in elderly patients with CRC after radical surgery is 9.9%-25.4%, and the incidence of grade 3-5 complications is 6.5%-20.1% [22][23][24][25] . Our study showed that the incidence rates of overall complications, grade 1-2 complications and grade 3-4 complications were 40.1%, 26.9% and 13.2%, respectively, which were consistent with previous reports in the literature.…”

“…Previous studies have only analysed the prognosis of elderly patients with CRC from a pathologicoanatomical tumour perspective [8][9][10][11][12][13][14][15] . However, due to their unique clinicopathological characteristics and lifestyle habits, some of the most common biological characteristics of elderly patients may be ignored, such as comorbidity, and body mass index (BMI), among other habits.…”