Octogenarian Patients with Colon Cancer – Postoperative Morbidity and Mortality are the Major Challenges

Abstract Background Few studies have addressed colon cancer surgery outcomes in an unselected cohort of octogenarian patients. The present study aimed to evaluate the relative survival of octogenarian patients after a major resection of colon cancer with a curative intent. Methods All patients diagnosed with colon cancer at Levanger Hospital between 1980 and 2016 were included. We performed logistic regression to test for associations between 100-day mortality and explanatory variables. We performed a relative survival analysis to identify factors associated with short- and long-term survival.Results Among 239 octogenarian patients treated with major resections with curative intent, the 100-day mortality was 10.1%. Among 215 patients that survived the first 100 days, the five-year relative survival rate was 99.7%. The 100-day mortality of octogenarian patients was significantly shorter than that of younger patients, but the long-term survival converged with that of younger patients. Among octogenarian patients, the incidence of colon cancer more than doubled during our 37-year observation period. The relative increase in patients undergoing surgery exceeded the increase in incidence; hence, more patients were selected for surgery over time. A high 100-day mortality was associated with older age, a high American Society of Anaesthesiologists (ASA) score, and emergency surgery. Moreover, worse long-term survival was associated with a high Charlson Comorbidity Index, a high ASA score, a worse TNM stage, emergency surgery and residual tumours. Both the 100‑day and long-term survival rates improved over time. Conclusion Among octogenarian patients with colon cancer that underwent major resections with curative intent, the 100-day mortality was high, but after surviving 100 days, the relative long-term survival rate was comparable to that of younger patients. Further improvements in survival will primarily require measures to reduce the 100-day mortality risk.

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Intraoperative Tumor Perforation is Associated with Decreased 5-Year Survival in Colon Cancer: A Nationwide Database Study

Scandinavian Journal of Surgery ◽

10.1177/1457496916683091 ◽

2017 ◽

Vol 106 (3) ◽

pp. 202-210

Author(s):

N. S. Bundgaard ◽

V. O. Bendtsen ◽

P. Ingeholm ◽

U. H. Seidelin ◽

K. H. Jensen

Keyword(s):

Colon Cancer ◽

Postoperative Mortality ◽

Curative Intent ◽

Term Survival ◽

Long Term Survival ◽

Increased Risk ◽

National Cohort ◽

Tumor Perforation ◽

Prognostic Importance

Background: It is a widely held belief that intraoperative tumor perforation in colon cancer impairs survival and causes local recurrence, although the prognostic importance remains unclear. Aim: The aim of this study was to assess the effect of unintended intraoperative tumor perforation on postoperative mortality and long-term survival. Material and Methods: This national cohort study was based on data from a prospectively maintained nationwide colorectal cancer database. We included 16,517 colon cancer patients who were resected with curative intent from 2001 to 2012. Results: Intraoperative tumor perforation produced a significantly impaired 5-year survival of 40% compared to 64% in non-perforated colon cancer. Intraoperative tumor perforation was an independent risk factor for death, hazard ratio 1.63 (95% confidence interval: 1.4–1.94), with a significantly increased 90-day postoperative mortality of 17% compared to 7% in non-perforated tumors, p < 0.001. We showed that tumor fixation, emergency operations, and laparotomies were associated with an increased risk of intraoperative tumor perforation. Conclusion: This nationwide study demonstrates that intraoperative tumor perforation in colon cancer is associated with statistically significant reduced long-term survival and increased postoperative mortality.

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The Relationship Between Severe Complications, Beta-Blocker Therapy and Long-Term Survival Following Emergency Surgery for Colon Cancer

World Journal of Surgery ◽

10.1007/s00268-019-05058-z ◽

2019 ◽

Vol 43 (10) ◽

pp. 2527-2535 ◽

Cited By ~ 2

Author(s):

Rebecka Ahl ◽

Peter Matthiessen ◽

Yang Cao ◽

Gabriel Sjolin ◽

Olle Ljungqvist ◽

...

Keyword(s):

Colon Cancer ◽

Beta Blocker ◽

Emergency Surgery ◽

Term Survival ◽

Blocker Therapy ◽

Long Term Survival ◽

Beta Blocker Therapy ◽

The Relationship

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Recent major improvement in long-term survival of younger patients with multiple myeloma

Blood ◽

10.1182/blood-2007-08-104984 ◽

2008 ◽

Vol 111 (5) ◽

pp. 2521-2526 ◽

Cited By ~ 382

Author(s):

Hermann Brenner ◽

Adam Gondos ◽

Dianne Pulte

Keyword(s):

Multiple Myeloma ◽

Relative Survival ◽

The United States ◽

Age Group ◽

Term Survival ◽

Period Analysis ◽

Younger Patients ◽

Long Term Survival ◽

The Past

In the past, most patients with multiple myeloma (MM) died within 5 to 10 years after diagnosis. Within the past decade, several new therapeutic interventions have been introduced, including autologous stem-cell transplantation, thalidomide, lenalidomide, and bortezomib. We estimated trends in age-specific 5- and 10-year relative survival of patients with MM in the United States from 1990-1992 to 2002-2004 from the 1973-2004 database of the Surveillance, Epidemiology, and End Results (SEER) Program. Techniques of period analysis were used to show most recent developments. Overall, 5-year relative survival increased from 28.8% to 34.7% (P < .001), and 10-year relative survival increased from 11.1% to 17.4% (P < .001) between 1990-1992 and 2002-2004. Much stronger increases were seen in the age group younger than 50 years, leading to 5- and 10-year relative survival of 56.7% and 41.3% in 2002-2004, and in the age group 50 to 59 years, leading to 5- and 10-year relative survival of 48.2% and 28.6% in 200-2004. By contrast, only moderate improvement was seen in the age group 60 to 69 years, and essentially no improvement was achieved among older patients. Our period analysis discloses a major increase in long-term survival of younger patients with MM in recent years, which most likely reflects the effect of recent advances in therapy and their dissemination in clinical practice.

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Long-Term Survival of Patients with a History of Venous Thromboembolism

Blood ◽

10.1182/blood.v116.21.3168.3168 ◽

2010 ◽

Vol 116 (21) ◽

pp. 3168-3168

Author(s):

Sylvia Elisabeth Reitter ◽

Thomas Waldhoer ◽

Michaela Mayerhofer ◽

Ernst Eigenbauer ◽

Cihan Ay ◽

...

Keyword(s):

Venous Thromboembolism ◽

Survival Rate ◽

Relative Survival ◽

Term Survival ◽

Long Term Survival ◽

Cumulative Survival ◽

History Of ◽

Austrian Population ◽

Long Term Mortality

Abstract Abstract 3168 Background: Only limited data are available regarding long-term survival following venous thromboembolism (VTE). Objectives: In our study, we aimed to evaluate the long-term mortality rate in patients having a history of deep vein thrombosis (DVT) and/or pulmonary embolism (PE). Patients were referred to our outpatient department for thombophilia testing. We assessed long-term mortality according to the etiology of VTE (spontaneous or following a triggering event) as well as according to the site of thrombosis. In addition, we investigated the relative survival of our patients in comparison to the general Austrian population. Patients/Methods: In our analysis, we included patients with a history of VTE (at least 3 months after a VTE event), who were examined at our out-patient department for routine thrombophilia testing between September 1, 1994 and December 31, 2007. We were provided with information concerning mortality and causes of death of our patients from the Austrian Central Death Registry. The data supplied by Statistics Austria was compared with mortality rates of the general Austrian population, which were also obtained through Statistics Austria. Results: Our study covered a total of 3209 patients (mean age 46.2, range 14–89 years, 1280 men = 40%). The median time interval between the initial occurrence of VTE and study inclusion was 14 months, the median observation period was 6.6 years. During the considered time period (September 1, 1994 and December 31, 2008) a total of 169 patients (5.3%) died, 6 patients died from definite and 2 from probable PE, another 6 patients died from bleeding. The remaining patients died from cancer (34%), cardiovascular causes others than PE (27%) or other diseases (30%). The cumulative survival rate of patients was 0.97 and 0.87 after 5 and 10 years, respectively, the death rate in men was higher than that of the women and the survival of patients with idiopathic VTE was lowest in comparison to those having a triggering event. When patients were compared to the general population, the cumulative relative survival was 1.02 (95% CI 1.00–1.03). In none of the analysed subgroups a reduced cumulative relative survival rate among our patients was noted. Male patients showed a tendency for a better relative survival (1.05, 95 % CI 1.03 – 1.08), whereas that of women (1.00, 95 % CI 0.98 – 1.01) equalled that of the normal population. Duration of anticoagulation (less than 6 months in comparison to more than 18 months after first VTE) did not have an influence on the cumulative survival rates (p = 0.96). Conclusion: Our findings indicate that after the critical initial period, VTE does not seem to have an impact on long-term survival of outpatients with a history of VTE without active malignancy. This is most likely due to the currently prevailing improved diagnostic and treatment modalities of recurrent VTE, which have proved to be most effective and safe. Disclosures: No relevant conflicts of interest to declare.

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Does body mass index impact the number of LNs harvested and influence long-term survival rate in patients with stage III colon cancer?

International Journal of Colorectal Disease ◽

10.1007/s00384-012-1496-5 ◽

2012 ◽

Vol 27 (12) ◽

pp. 1625-1635 ◽

Cited By ~ 17

Author(s):

Yi-Hung Kuo ◽

Kam-Fai Lee ◽

Chih-Chien Chin ◽

Wen-Shih Huang ◽

Chung-Hung Yeh ◽

...

Keyword(s):

Body Mass Index ◽

Colon Cancer ◽

Survival Rate ◽

Body Mass ◽

Stage Iii ◽

Term Survival ◽

Long Term Survival ◽

Stage Iii Colon Cancer

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The Anti-PD-1/PD-L1 Immunotherapy for Gastric Esophageal Cancer: A Systematic Review and Meta-Analysis and Literature Review

Cancer Control ◽

10.1177/1073274821997430 ◽

2021 ◽

Vol 28 ◽

pp. 107327482199743

Author(s):

Ke Chen ◽

Xiao Wang ◽

Liu Yang ◽

Zheling Chen

Keyword(s):

Overall Survival ◽

Esophageal Cancer ◽

Survival Rate ◽

Meta Analysis ◽

Response Rates ◽

Control Group ◽

Term Survival ◽

Long Term Survival ◽

And Control

Background: Treatment options for advanced gastric esophageal cancer are quite limited. Chemotherapy is unavoidable at certain stages, and research on targeted therapies has mostly failed. The advent of immunotherapy has brought hope for the treatment of advanced gastric esophageal cancer. The aim of the study was to analyze the safety of anti-PD-1/PD-L1 immunotherapy and the long-term survival of patients who were diagnosed as gastric esophageal cancer and received anti-PD-1/PD-L1 immunotherapy. Method: Studies on anti-PD-1/PD-L1 immunotherapy of advanced gastric esophageal cancer published before February 1, 2020 were searched online. The survival (e.g. 6-month overall survival, 12-month overall survival (OS), progression-free survival (PFS), objective response rates (ORR)) and adverse effects of immunotherapy were compared to that of control therapy (physician’s choice of therapy). Results: After screening 185 studies, 4 comparative cohort studies which reported the long-term survival of patients receiving immunotherapy were included. Compared to control group, the 12-month survival (OR = 1.67, 95% CI: 1.31 to 2.12, P < 0.0001) and 18-month survival (OR = 1.98, 95% CI: 1.39 to 2.81, P = 0.0001) were significantly longer in immunotherapy group. The 3-month survival rate (OR = 1.05, 95% CI: 0.36 to 3.06, P = 0.92) and 18-month survival rate (OR = 1.44, 95% CI: 0.98 to 2.12, P = 0.07) were not significantly different between immunotherapy group and control group. The ORR were not significantly different between immunotherapy group and control group (OR = 1.54, 95% CI: 0.65 to 3.66, P = 0.01). Meta-analysis pointed out that in the PD-L1 CPS ≥10 sub group population, the immunotherapy could obviously benefit the patients in tumor response rates (OR = 3.80, 95% CI: 1.89 to 7.61, P = 0.0002). Conclusion: For the treatment of advanced gastric esophageal cancer, the therapeutic efficacy of anti-PD-1/PD-L1 immunotherapy was superior to that of chemotherapy or palliative care.

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