Abstract
Objectives
To determine the combined effect of age and comorbidity on receipt of chemotherapy
and its impact on survival in elderly patients with stage III colorectal cancer (CRC).
Materials and methods
All patients over age 65 with stage III CRC diagnosed in 1996–2006 were identified
from the Barnes-Jewish Hospital Oncology Data Services registry. An age/comorbidity
staging system was created using the ACE-27 comorbidity index and data from both stage
II and III CRC. The staging system was then applied to patients with stage III CRC.
Odds of receiving chemotherapy were calculated, and survival analyses determined the
impact of chemotherapy on overall survival in each age/comorbidity stage.
Results
435 patients with stage III CRC were evaluated [median age 75 years (range 65–99)]. Advancing age/comorbidity stage (Alpha, Beta, Gamma) was associated
with decreasing odds of receiving chemotherapy for stage III CRC [odds ratio 0.83
(95% CI, 0.51–1.35) for Beta and 0.14 (95% CI, 0.08–0.24) for Gamma, compared to Alpha].
Chemotherapy was associated with lower risk of death in each of the age/comorbidity
stages, compared to those who underwent surgery only. The hazard ratio for death in
patients who did not receive chemotherapy, relative to those who did, within each
age/comorbidity stage was 1.8 [95% CI 1.06–3.06] for Alpha, 2.24 [95% CI 1.38–3.63]
for Beta and 2.10 [95% CI 1.23–3.57] for Gamma.
Conclusion
While stage III CRC patients with increasing age and comorbidity are less likely to
receive chemotherapy, receipt of chemotherapy is associated with a lower risk of death.
Keywords
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Article info
Publication history
Published online: September 20, 2010
Accepted:
August 6,
2010
Received in revised form:
July 23,
2010
Received:
June 16,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
