Colorectal cancer outcomes in patients aged over 85 years

IntroductionThe prevalence of colorectal cancer is increasing in the elderly. We examined the treatment and outcomes in our institution of patients aged over 85 years with proven colorectal adenocarcinoma.MethodsOne hundred and five patients were identified and stratified by treatment received: curative surgery (CS), other treatments (OT) or best supportive care (BSC). Data on demographics, staging, treatment and survival was collected and analysed.ResultsForty two patients received CS, 36 OT and 27 BSC. While the treated groups (CS and OT) were similar in terms of age (p=0.35) and staging (p=0.16), BSC patients were significantly older and had higher stage disease (p<0.01). Survival was significantly poorer among BSC patients, at a mean of 9.7 months (95% confidence interval [CI] 4.7–14.7) versus 41.6 months (95% CI 32.5–50.7) and OT 27.3 months (95% CI 20.4–34.1) for the CS and OT groups (p<0.001). There was no significant survival difference between CS and OT groups within 2 years of treatment (p=0.12). Thereafter, OT patients had a very similar 5-year survival to that of the BSC group, at 13% versus 43% in CS patients (p<0.001).ConclusionsThese data suggest that, up to 2 years following treatment, the risks of resectional surgery for colorectal cancer may neutralise any benefit. However, those that survive beyond this period show improvements. The challenge of improving patient selection is most acute in the growing ageing population, and highlights the current focus on presenting all treatment options to ‘a reasonable patient’.

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Sidedness and prognostic factors of peritoneal metastatic colorectal cancer: A single center experience.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e15050 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e15050-e15050

Author(s):

Aysegul Ilhan ◽

Umut Demirci ◽

Bulent Aksel ◽

Ferit Aslan ◽

Lutfi Dogan ◽

...

Keyword(s):

Colorectal Cancer ◽

Peritoneal Metastasis ◽

Single Center Experience ◽

First Line Therapy ◽

Primary Surgery ◽

Survival Difference ◽

Significant Survival ◽

Single Centre Experience ◽

Significant Difference ◽

Visceral Metastases

e15050 Background: Peritoneal metastasis in colorectal cancer (pCRC) is associated with poor prognosis. This study aimed to present a single centre experience for patients with pCRC. Methods: Between 2012 and 2016, 60 patients diagnosed with pCRC included in this study. Demographic and clinico-pathologic characterictics of patients were retrospectively analysed using patient medical records. Results: A total of 60 patients (31 female) were included and the median age was 61. Fifty-five patients (91%) had peritoneal metastases at the initial diagnosis, 37 patients (61%) had the left-sided colon cancer and 33 patients (55%) had the visceral metastases. Peritoneal metastasis was detected in 7 patients during the primary surgery. 30 patients (50%) received biologic therapy; 25 patients (41.6%) received anti-VEGF (bev) and 5 patients (8.3%) received anti-EGFR (cet/ pan) as the first line therapy. Seven (11%) patients underwent cytoreductive surgery and HIPEC. Median PFS of the analyzed patients was 10 months (SE: 2; 95% CI 6-13.9) and mOS was 20 months (SE: 4.2; 95% CI 11.7-28.7). The mPFS and mOS were 16.6 months (SE: 4.9; 95% CI 6.9-26.4) and 28 months (SE:7.1; 95% CI 13.8-42.1) in the group received surgery and HIPEC, respectively. No statistically significant survival difference was detected in terms of primary tumor localization, the presence of visceral metastasis (Table 1). Conclusions: In our study, the prognosis of pCRC patients was observed to be worse regardless of localization and the presence of accompanying visceral disease. A statistically significant difference was observed in the survival of the patients that received biologics. [Table: see text]

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COLORECTAL CANCER IN THE ELDERLY. IS THERE A ROLE FOR SAFE AND CURATIVE SURGERY?

ANZ Journal of Surgery ◽

10.1111/j.1445-2197.2008.04536.x ◽

2008 ◽

Vol 78 (6) ◽

pp. 466-470 ◽

Cited By ~ 49

Author(s):

Giancarlo Basili ◽

Luca Lorenzetti ◽

Graziano Biondi ◽

Enrico Preziuso ◽

Claudio Angrisano ◽

...

Keyword(s):

Colorectal Cancer ◽

The Elderly ◽

Curative Surgery

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Adjuvant chemotherapy (AC) for stage III colorectal cancer (CRC) in the elderly: An Irish experience.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.54 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 54-54 ◽

Cited By ~ 1

Author(s):

Emily Harrold ◽

Megan Greally ◽

Niamh Peters ◽

Jane Sze Yin Sui ◽

John McCaffrey

Keyword(s):

Risk Group ◽

Stage Iv ◽

Risk Groups ◽

The Elderly ◽

High Risk Group ◽

Low Risk ◽

Stage Iii ◽

Tertiary Referral Centre ◽

Survival Difference ◽

Significant Survival

54 Background: Since 2004 6 months of adjuvant Oxaliplatin containing regimens (OCR) has been standard of care for Stage III CRC despite cumulative neurotoxicity. The IDEA collaboration evaluated 3 versus 6 months of OCR in high/low risk pts with regard to peripheral neuropathy (PN) and efficacy.The median pt age was 64; individual studies included pts ≤85. Methods: This study is part of a retrospective review of the clinicopathological records of consecutive CRC pts referred to the multi-disciplinary CRC team at an Irish tertiary referral centre from 2002-2018. We recorded pt characteristics, Rx received and outcomes. Overall Survival (OS) was assessed using Kaplan-Meier analysis. Results: 869 pts were identified; 37% (328) female. 63% (551/869) < 70 and 37% (318/869) ≥ 70. Median OS for < 70 cohort was 31.5 months versus 19 months in ≥ 70 cohort (p < 0.0001).Stage distribution in < 70: ≥70 cohorts was Stage II 14%( 79/551):20% (63/318), Stage III 47% (260/55):46% (142/318) and Stage IV 38% (207/551):34% (111/318). In < 70 Stage III cohort 7% (37/551) pts received no AC, 42%(230/551) received FOLFOX, 3%(16/551) received FLOX or XELOX, 7%(38/551) received 5FU/LEU. 32%(78/246) of pts < 70 developed PN with persistence at 6 months in 18%(44/256). In ≥ 70 Stage III cohort 58%(83/142) did not received AC. 23%(32/142) received an OCR and 16%(23/142) received 5FU/LEU; there was a statistically significant survival difference with an OCR. 47% (15/32) of pts ≥70 receiving OCR developed PN which persisted at 6 months in 28% (9/32). In < 70 cohort there was no significant survival difference in the IDEA-trial-defined low risk group between 12 versus < 12 FOLFOX. There was a numerical survival difference in the < 70 high risk group between 12 versus < 12 FOLFOX; this was not statistically significant. In the ≥70 age group there was no survival difference in either IDEA risk groups for 12 versus < 12 FOLFOX. Conclusions: > 50% of Stage III CRC patients ≥ 70 did not receive AC. OCRs were associated with a significant OS improvement but with higher PN than in < 70 cohort and higher persistence at 6 months. Irrespective of IDEA-defined risk groups,there was no statistically significant survival difference for Stage III CRC ≥70 receiving 12 versus < 12 FOLFOX.

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Survival in previously treated advanced NSCLC: Pemetrexed versus best supportive care (BSC)

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.17015 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 17015-17015

Author(s):

F. V. Fossella ◽

D. A. Berry ◽

S. Adachi ◽

P. McAndrews ◽

P. Peterson

Keyword(s):

Proportional Hazards ◽

Advanced Nsclc ◽

Kinase Inhibitor ◽

Treatment Options ◽

Single Agent ◽

Best Supportive Care ◽

Significant Survival ◽

Previously Treated ◽

Interstudy Variability ◽

Summary Data

17015 Background: Patients with advanced NSCLC who progress following initial treatment have several approved secondary treatment options including single agent intravenous chemotherapy (docetaxel or pemetrexed) and an oral EGFR tyrosine kinase inhibitor (erlotinib). Docetaxel and erlotinib were shown in randomized trials to have an overall survival (OS) advantage over BSC. On the other hand, pemetrexed was approved based on a randomized trial (JMEI) in which it showed clinically equivalent survival to docetaxel. Investigators felt that it was not ethical to compare pemetrexed to BSC because docetaxel was approved in that setting. However, indirect comparisons of pemetrexed with BSC are possible and are legitimate statistically. Methods: We used summary data from JMEI and TAX317(b) in the analysis. Studies BR21 and ISEL provide relevant data from recent trials with a BSC arm. We based comparisons on the logarithms of these HRs and their variances in proportional hazards models, accounting for interstudy variability. Results: Patients in these studies had similar prognostic characteristics. Docetaxel in TAX317(b) showed a significant survival benefit over BSC (HR = 0.56, 95% CI 0.35–0.88). In JMEI, the pemetrexed over docetaxel HR was 0.99 (95% CI 0.82–1.20). The HR of pemetrexed over BSC for survival was 0.55 (95% CI 0.33–0.90). The similarity of median OS for the placebo (or BSC) arms of studies TAX317(b), BR21 and ISEL supports the above analysis. Conclusions: In comparison with BSC pemetrexed lowers the hazard of mortality in previously treated advanced NSCLC by an estimated 45% (95% CI 10%-67%). [Table: see text] [Table: see text]

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Chromogranin-A Expression in Neoplastic Neuroendocrine Cells and Prognosis in Colorectal Cancer

Tumori Journal ◽

10.1177/030089169608200419 ◽

1996 ◽

Vol 82 (4) ◽

pp. 390-393 ◽

Cited By ~ 7

Author(s):

Giovanni Battista Secco ◽

Elisabetta Campora ◽

Roberto Fardelli ◽

Gabriella Lapertosa ◽

Francesca De Lucchi ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Patients ◽

Chromogranin A ◽

Colorectal Adenocarcinoma ◽

Tumor Grade ◽

Neuroendocrine Cells ◽

Human Gastrointestinal Tract ◽

Curative Surgery ◽

Group Iii ◽

Colorectal Cancer Patients

Aims Chromogranin-A (CG), a cytoplasmic glycoprotein, is one of the markers most frequently used to identify the presence of neuroendocrine cells in the human gastrointestinal tract. Several authors have identified a subgroup of colorectal cancer patients with a severe prognosis whose tumors contained neuroendocrine CG-positive cells. In the present study, CG expression in 100 patients with colorectal adenocarcinoma treated from January 1983 to December 1988 with potentially curative surgery was analyzed and correlated with other prognostic factors and 5-year survival rate. Methods Samples tested immunohistochemically for CG were divided into three groups: I) negative; II) less than 1 CG-positive cell/mm2; III) more than 1 CG-positive cell/mm2. Results Of 100 patients with primary colorectal adenocarcinoma, 79% had tumors comprised of CG-negative cells, 17% had rare CG-positive cells, and 4% of cases could be classified in group III. No significant relation between CG expression and location of primary tumor, bowel wall infiltration, stage of disease or tumor grade according to Broders and Jass was observed. The 5-year survival was 53% and 52% for CG-positive and CG-negative lesions, respectively. Survival of patients with Dukes-Kirklin stage C and D was comparable in patients with CG-positive (33.3%) and CG-negative (30%) tumors. Conclusions CG expression cannot, at present, be recommended as a marker to identify prognostic subgroups in colorectal cancer patients.

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Common Controversies in the Management of Gallbladder Cancer

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2014.0201 ◽

2014 ◽

Vol 12 (5S) ◽

pp. 833-835 ◽

Cited By ~ 1

Author(s):

Chandrakanth Are

Keyword(s):

Gallbladder Cancer ◽

Early Stage ◽

Treatment Options ◽

High Volume ◽

Best Supportive Care ◽

Centers Of Excellence ◽

Early Stage Disease ◽

Stage Disease ◽

Evidence Based Care ◽

To Receive

Gallbladder cancer is a rare and lethal malignancy. Most patients are best served at high-volume centers of excellence, where they are likely to receive evidence-based care derived from a multidisciplinary approach. Surgical resection is recommended for early-stage disease, whereas if the disease is unresectable, the treatment options include biliary drainage, gemcitabine-based combination chemotherapy, fluoropyrimidine chemoradiation, clinical trial enrollment, or best supportive care. While treatment by T-stage is straightforward in many cases, the debate regarding simple versus radical cholecystectomy is still active for patients with T1b disease. Other controversies exist over the necessity of resecting the bile duct and port sites, the extent of lymph node dissection and hepatic resections, and the value of resection for patients with jaundice.

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Outcome of Colorectal cancer in Geriatric Patient

Cancer Research and Cellular Therapeutics ◽

10.31579/2640-1053/094 ◽

2021 ◽

Vol 5 (4) ◽

pp. 01-07

Author(s):

Ashfaq Chandio ◽

Anil Rai ◽

Mehak Chandio ◽

Asirvatham Rhody ◽

Katherine Brown

Keyword(s):

Colorectal Cancer ◽

Postoperative Outcome ◽

Best Supportive Care ◽

Management Plan ◽

University Hospital ◽

Surgical Patient ◽

Curative Surgery ◽

Inappropriate Care ◽

Increased Risk ◽

Age Range

Background: Older surgical patients remain at increased risk of adverse postoperative outcome when undergoing both elective and emergency surgery. The needs of the older surgical patient are often substantially different from those of younger patients. As a surgeons we have dilemmas in appropriately treating elderly patients. Specifically, those with cancer have been shown to receive inappropriate care, being either undertreated or overtreated based on their chronological age rather than their degree of frailty. Aim:To evaluate outcome of patients diagnosed with colorectal cancer in patients aged 80 years and over. Methods:Retrospective study of all patients 80 years and above managed with colorectal cancer at the Luton and Dunstable University Hospital UK from January 2015 through December 2019 Results: In the study period 278 patients were diagnosed with colorectal cancer, Male 143 Female 135 ratio 1:1.05. Age range from 80 to 101years. 54.31% patients underwent surgical intervention. 15.10% had complications after surgery. 36.69% patients deemed unsuitable for resection surgery were treated with best supportive care palliatively. 57.19% patients were in ASAIII, 24.10% ASAII and 12.23% ASAIV. 46.40% patients died during the study period. Conclusion:Age on its own would not be taken as for less aggressive therapy; Careful assessment of the patient taking into consideration comorbidities, functional status and patient wishes are essential in decision making and choosing appropriate management plan. Curative surgery for colorectal carcinoma in the geriatric patients are well tolerated. Management of comorbidities preceding surgery may impact postoperative outcome.

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Colorectal Cancer: Relationship of Histologic Grading to Disease Prognosis

Tumori Journal ◽

10.1177/030089168306900616 ◽

1983 ◽

Vol 69 (6) ◽

pp. 581-584 ◽

Cited By ~ 6

Author(s):

Edoardo Berti Riboli ◽

Giovanni Battista Secco ◽

Gabriella Lapertosa ◽

Carmine Di Somma ◽

Ferdinando Santi ◽

...

Keyword(s):

Colorectal Cancer ◽

Colorectal Adenocarcinoma ◽

Tnm Classification ◽

Good Method ◽

Curative Surgery ◽

Poorly Differentiated Adenocarcinoma ◽

Poorly Differentiated ◽

Relationship Of

Ninety patients underwent curative surgery for colorectal adenocarcinoma and they were followed for a period of 3 years. The aim of this retrospective study was to relate the cell differentiation (grading) and TNM classification of the UICC (1978) with the disease evaluation and patient survival. The results showed a consistent relation between grading and lymph node metastasis in patients with moderately and poorly differentiated adenocarcinoma, whereas no relationship was found between grading and local invasion of the tumor. Therefore, histocytologic grading of colorectal cancer appears to significantly influence survival grading parameters, and it may be a good method for monitoring the disease and follow-up of the patients.

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A Biobank of Colorectal Cancer Patient-Derived Xenografts

Cancers ◽

10.3390/cancers12092340 ◽

2020 ◽

Vol 12 (9) ◽

pp. 2340

Author(s):

Suad M. Abdirahman ◽

Michael Christie ◽

Adele Preaudet ◽

Marie C. U. Burstroem ◽

Dmitri Mouradov ◽

...

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Mortality Rate ◽

Colorectal Cancer Patient ◽

Treatment Options ◽

Disease Patient ◽

Stage Iv ◽

Stage Disease ◽

Late Stage Disease ◽

Pdx Models

Colorectal cancer (CRC) is a challenging disease, with a high mortality rate and limited effective treatment options, particularly for late-stage disease. Patient-derived xenografts (PDXs) have emerged as an informative, renewable experimental resource to model CRC architecture and biology. Here, we describe the generation of a biobank of CRC PDXs from stage I to stage IV patients. We demonstrate that PDXs within our biobank recapitulate the histopathological and mutation features of the original patient tumor. In addition, we demonstrate the utility of this resource in pre-clinical chemotherapy and targeted treatment studies, highlighting the translational potential of PDX models in the identification of new therapies that will improve the overall survival of CRC patients.

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