To identify independent predictors of post-operative complications and early mortality in elderly patients operated for colorectal cancer from a comprehensive geriatric assessment [CGA] and Eastern Cooperative Oncology Group performance status [PS].
Patients and Methods
Patients ≥70 years electively operated for all stages of colorectal cancer from 2006 to 2008 in three hospitals were consecutively included. CGA addressed the following domains pre-operatively: personal and instrumental activities of daily living [IADL], comorbidity, polypharmacy, nutrition, cognition, and depression. The associations between elements of CGA as well as PS and morbidity and mortality were analyzed using multivariate regression models.
Patients (182) with a median age of 80 years (range, 70–94 years) were included. Severe comorbidity was an independent predictor of severe complications (odds ratio [OR] 5.62; 95% CI 2.18 to 14.50) and early mortality (hazard ratio [HR] 2.78; 95% CI 1.50 to 5.17). IADL-dependency and depression were predictors of any complication (OR 4.02; 95% CI 1.24 to 13.09 and OR 3.68; 95% CI 0.96 to 14.08, respectively) while impaired nutrition predicted early mortality (HR 2.39, 95% CI 1.24 to 4.61). When added to the models, PS independently predicted both morbidity and early mortality, and PS was a more powerful predictor than IADL-dependency, depression, and impaired nutrition.
In elderly patients with colorectal cancer, severe comorbidity, IADL-dependency, depression, and impaired nutrition seem to be the most important CGA-elements predictive of post-operative complications and early mortality. As PS predicts all outcomes, a consistent use of PS in studies of cancer surgery is recommended.
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Dr. Kristjansson is a research fellow at the Department of Geriatric Medicine, Oslo University Hospital, Ullevål and at the University of Oslo. She is specializing in internal medicine and geriatric medicine. The focus of her research is the integration of a comprehensive geriatric assessment in the pre-operative evaluation of elderly cancer patients, and the identification of frailty in elderly patients.
Published online: July 22, 2010
Accepted: June 11, 2010
Received: June 8, 2010
☆Funding: The study is supported by a research grant from the Norwegian Cancer Society (to S.R.K.).
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.