scholarly journals Disparate Use of Chemoradiation in Elderly Patients With Localized Anal Cancer

2021 ◽  
pp. 1-9
Author(s):  
Eric D. Miller ◽  
Ansel P. Nalin ◽  
Dayssy A. Diaz Pardo ◽  
Andrea L. Arnett ◽  
Emily Huang ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Propensity Score ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Odds Ratio ◽  
Single Agent ◽  
The Elderly ◽  
Multiagent Chemotherapy ◽  
To Receive ◽  
Single Agent Chemotherapy

Background: The incidence of squamous cell carcinoma of the anus (SCCA) is increasing, particularly among the elderly (age ≥65 years). We sought to compare patterns of care for the treatment of SCCA in elderly versus nonelderly patients. Methods: Data for patients with stages I–III SCCA diagnosed from 2004 through 2015 were obtained from the National Cancer Database. Patients were categorized as having received standard-of-care (SOC) chemoradiation (CRT) with multiagent chemotherapy, non-SOC therapy, palliative therapy, or no treatment. Differences in treatment groups were tested using the chi-square test. We used logistic regression to identify predictors of SOC CRT and multiagent versus single-agent chemotherapy in patients receiving CRT. Propensity score matching was used to compare overall survival (OS) in elderly patients receiving multiagent versus single-agent chemotherapy for those receiving CRT. Results: We identified 9,156 elderly and 17,640 nonelderly patients. A lower proportion of elderly versus nonelderly patients (54.5% vs 65.0%; P<.0001) received SOC CRT than other treatments or no treatment. In multivariate analysis, elderly patients were 38% less likely than nonelderly patients to receive SOC CRT (odds ratio, 0.62; 95% CI, 0.58–0.65; P<.0001). A higher proportion of the elderly were treated with single-agent versus multiagent chemotherapy (16.9% vs 11.8%; P<.0001), which resulted in a >1.5-fold increase in the likelihood of elderly patients receiving single-agent chemotherapy (odds ratio, 1.52; 95% CI, 1.39–1.66) in multivariate analysis. After propensity score matching, 3-year OS was higher in elderly patients who received CRT with multiagent versus single-agent chemotherapy (77.1% vs 67.5%; hazard ratio, 0.78; 95% CI, 0.68–0.89; P=.0002). Conclusions: In this comprehensive study of patients with stages I–III SCCA, elderly patients were less likely than nonelderly patients to receive SOC CRT. The low proportion of elderly patients receiving SOC CRT with multiagent chemotherapy for localized anal cancer suggests that the optimal treatment approach for this vulnerable population remains undefined.

scholarly journals Liver resection for colorectal liver-limited metastases in elderly patients: a propensity score matching analysis

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Ke-Min Jin ◽  
Kun Wang ◽  
Quan Bao ◽  
Hong-Wei Wang ◽  
Bao-Cai Xing
Keyword(s):  
Propensity Score ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Disease Free Survival ◽  
The Elderly ◽  
Multivariate Regression Analysis ◽  
Cancer Specific Survival ◽  
Younger Patients ◽  
Propensity Score Matching Analysis ◽  
American Society

Abstract Background Few studies have focused on the role of hepatectomy for colorectal liver-limited metastases in elderly patients compared to matched younger patients. Methods From January 2000 to December 2018, 724 patients underwent hepatectomy for colorectal liver-limited metastases. Based on a 1:2 propensity score matching (PSM) model, 64 elderly patients (≥ 70 years of age) were matched to 128 younger patients (< 70 years of age) to obtain two balanced groups with regard to demographic, therapeutic, and prognostic factors. Results There were 73 elderly and 651 younger patients in the unmatched cohort. Compared with the younger group (YG), the elderly group (EG) had significantly higher proportion of American Society of Anesthesiologists score III and comorbidities and lower proportion of more than 3 liver metastases and postoperative chemotherapy (p < 0.05). After PSM for these factors, rat sarcoma virus proto-oncogene/B-Raf proto-oncogene (RAS/BRAF) mutation status and primary tumor sidedness, the EG had significantly less median intraoperative blood loss than the YG (175 ml vs. 200 ml, p = 0.046), a shorter median postoperative hospital stay (8 days vs. 11 days, p = 0.020), and a higher readmission rate (4.7% vs.0%, p = 0.036). The EG also had longer disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS) compared to the YG, but these findings were not statistically significant (p > 0.05). Old age was not an independent factor for DFS, OS, and CSS by Cox multivariate regression analysis (p > 0.05). Conclusions Hepatectomy is safe for colorectal liver-limited metastases in elderly patients, and these patients may subsequently benefit from prolonged DFS, OS, and CSS.

scholarly journals Liver Resection for Colorectal Liver-limited Metastases in Elderly Patients: A Propensity Score Matching Analysis

2020 ◽  
Author(s):  
Ke-Min Jin ◽  
Kun Wang ◽  
Quan Bao ◽  
Hong-Wei Wang ◽  
Bao-Cai Xing
Keyword(s):  
Propensity Score ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Disease Free Survival ◽  
The Elderly ◽  
Multivariate Regression Analysis ◽  
Cancer Specific Survival ◽  
Younger Patients ◽  
Propensity Score Matching Analysis ◽  
American Society

Abstract Background: Few studies have focused on the role of hepatectomy for colorectal liver-limited metastases in elderly patients compared to matched younger patients.Methods: From January 2000 to December 2018, 724 patients underwent hepatectomy for colorectal liver-limited metastases. Based on a 1:2 propensity score matching (PSM) model, 64 elderly patients (≥70 years of age) were matched to 128 younger patients (＜70 years of age) to obtain two balanced groups with regards to demographic, therapeutic and prognostic factors.Results: There were 73 elderly and 651 younger patients in the unmatched cohort. Compared with the younger group (YG), the elderly group (EG) had significantly higher proportion of American Society of Anesthesiologists score Ⅲ and comorbidities, and lower proportion of more than 3 liver metastases and postoperative chemotherapy (p<0.05). After PSM for these factors, rat sarcoma virus proto-oncogene/B-Raf proto-oncogene (RAS/BRAF) mutation status and primary tumor sidedness, the EG had significantly less median intraoperative blood loss than the YG (175ml vs. 200ml, p=0.046), a shorter median postoperative hospital stay (8 days vs. 11 days, p=0.020) and a higher readmission rate (4.7% vs.0%, p=0.036). The EG also had longer disease-free survival (DFS), overall survival (OS) and cancer-specific survival (CSS) compared to the YG, but these findings were not statistically significant (p>0.05). Old age was not an independent factor for DFS, OS and CSS by Cox multivariate regression analysis (p>0.05).Conclusions: Hepatectomy is safe for colorectal liver-limited metastases in elderly patients, and these patients may subsequently benefit from prolonged DFS, OS and CSS.

scholarly journals Feasibility of subtotal esophagectomy with systematic lymphadenectomy in selected elderly patients with esophageal cancer; a propensity score matching analysis

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Mitsuro Kanda ◽  
Masahiko Koike ◽  
Chie Tanaka ◽  
Daisuke Kobayashi ◽  
Masamichi Hayashi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Propensity Score ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Propensity Score Analysis ◽  
Neoadjuvant Treatment ◽  
The Elderly ◽  
Elderly Group ◽  
Elderly Age ◽  
Subtotal Esophagectomy

Abstract Background The global increase in elderly populations is accompanied by an increasing number of candidates for esophagectomy. Here we aimed to determine the postoperative outcomes after subtotal esophagectomy in elderly patients with esophageal cancer. Methods Patients (n = 432) with who underwent curative-intent transthoracic subtotal esophagectomy with 2- or 3-field lymphadenectomies for thoracic esophageal cancer were classified as follows: non-elderly (age < 75 years, n = 373) and elderly (age ≥ 75 years, n = 59) and groups. To balance the essential variables including neoadjuvant treatment and stage of progression, we conducted propensity score analysis, and clinical characteristics, perioperative course and prognosis were compared. Results After two-to-one propensity score matching, 100 and 50 patients were classified in the non-elderly and elderly groups. The elderly group had more comorbidities and lower preoperative cholinesterase activities and prognostic nutrition indexes. Although incidences of postoperative pneumonia, arrhythmia and delirium were slightly increased in the elderly group, no significant differences were observed in overall incidence of postoperative complications, rates of repeat surgery and death caused by surgery, and length of postoperative hospital stay between the two groups. There were no significant differences in disease-free and disease-specific survival as well as overall survival between the two groups. Conclusion Older age (≥75 years) had limited impact on morbidity, disease recurrence, and survival after subtotal esophagectomy. Therefore, age should not prevent older patients from benefitting from surgery.

scholarly journals Comparative Quality of Laparoscopic and Open Cholecystectomy in the Elderly Using Propensity Score Matching Analysis

2010 ◽  
Vol 2010 ◽  
pp. 1-10 ◽  
Author(s):  
Kazuaki Kuwabara ◽  
Shinya Matsuda ◽  
Koichi Benjamin Ishikawa ◽  
Hiromasa Horiguchi ◽  
Kenji Fujimori
Keyword(s):  
Postoperative Complications ◽  
Propensity Score ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Open Cholecystectomy ◽  
Severe Disease ◽  
The Elderly ◽  
Propensity Score Matching Analysis ◽  
Safe Technique

The safety of laparoscopic cholecystectomy (LC) in patients ≥65 years of age requires further investigation of postoperative outcomes before it becomes more widely accepted as a safe technique. The advantages of using LC versus open cholecystectomy (OC) in elderly patients were analyzed using propensity score matching. The demographics, cholecystitis severity, comorbidities, complications, and admission and discharge Barthel Index (BI) scores of patients with benign gallbladder diseases were analyzed. Outcomes were analyzed by age, length of stay (LOS), total charges (TCs), BI improvement, and postoperative complications. OC, which was indicated in severe disease cases, increased hospital resource use and caused more complications than LC, but did not improve BI. Advanced age and OC resulted in greater LOS and TCs and was the best indicator of BI deterioration. Whenever possible, surgeons should use LC in elderly patients to minimize postoperative complications and allow them to regain a good quality of life.

scholarly journals Liver Resection for Colorectal Liver-limited Metastases in Elderly Patients: A Propensity Score Matching Analysis

2020 ◽  
Author(s):  
Ke-Min Jin ◽  
Kun Wang ◽  
Quan Bao ◽  
Hong-Wei Wang ◽  
Bao-Cai Xing
Keyword(s):  
Propensity Score ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Disease Free Survival ◽  
The Elderly ◽  
Multivariate Regression Analysis ◽  
Cancer Specific Survival ◽  
Younger Patients ◽  
Propensity Score Matching Analysis ◽  
American Society

Abstract Background: Few studies have focused on the role of hepatectomy for colorectal liver-limited metastases in elderly patients compared to matched younger patients.Methods: From January 2000 to December 2018, 724 patients underwent hepatectomy for colorectal liver-limited metastases. Based on a 1:2 propensity score matching (PSM) model, 64 elderly patients (≥ 70 years of age) were matched to 128 younger patients (༜70 years of age) to obtain two balanced groups with regards to demographic, therapeutic and prognostic factors.Results: There were 73 elderly and 651 younger patients in the unmatched cohort. Compared with the younger group (YG), the elderly group (EG) had significantly higher proportion of American Society of Anesthesiologists score Ⅲ and comorbidities, and lower proportion of more than 3 liver metastases and postoperative chemotherapy (p < 0.05). After PSM for these factors, rat sarcoma virus proto-oncogene/B-Raf proto-oncogene (RAS/BRAF) mutation status and primary tumor sidedness, the EG had significantly less median intraoperative blood loss than the YG (175 ml vs. 200 ml, p = 0.046), a shorter median postoperative hospital stay (8 days vs. 11 days, p = 0.020) and a higher readmission rate (4.7% vs.0%, p = 0.036). The EG also had longer disease-free survival (DFS), overall survival (OS) and cancer-specific survival (CSS) compared to the YG, but these findings were not statistically significant (p > 0.05). Old age was not an independent factor for DFS, OS and CSS by Cox multivariate regression analysis (p > 0.05).Conclusions: Hepatectomy is safe for colorectal liver-limited metastases in elderly patients, and these patients may subsequently benefit from prolonged DFS, OS and CSS.

scholarly journals Liver Resection for Colorectal Liver-limited Metastases in Elderly Patients: A Propensity Score Matching Analysis

2020 ◽  
Author(s):  
Ke-Min Jin ◽  
Kun Wang ◽  
Quan Bao ◽  
Hong-Wei Wang ◽  
Bao-Cai Xing
Keyword(s):  
Propensity Score ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Disease Free Survival ◽  
The Elderly ◽  
Multivariate Regression Analysis ◽  
Cancer Specific Survival ◽  
Younger Patients ◽  
Propensity Score Matching Analysis ◽  
American Society

Abstract Background: Few studies have focused on the role of hepatectomy for colorectal liver-limited metastases in elderly patients compared to matched younger patients. Methods: From January 2000 to December 2018, 724 patients underwent hepatectomy for colorectal liver-limited metastases. Based on a 1:2 propensity score matching (PSM) model, 64 elderly patients (≥70 years of age) were matched to 128 younger patients (＜70 years of age) to obtain two balanced groups with regards to demographic, therapeutic and prognostic factors.Results: There were 73 elderly and 651 younger patients in the unmatched cohort. Compared with the younger group (YG), the elderly group (EG) had significantly higher proportion of American Society of Anesthesiologists score Ⅲ and comorbidities, and lower proportion of more than 3 liver metastases and postoperative chemotherapy (p<0.05). After PSM for these factors, rat sarcoma virus proto-oncogene/B-Raf proto-oncogene (RAS/BRAF) mutation status and primary tumor sidedness, the EG had significantly less median intraoperative blood loss than the YG (175ml vs. 200ml, p=0.046), a shorter median postoperative hospital stay (8 days vs. 11 days, p=0.020) and a higher readmission rate (4.7% vs.0%, p=0.036). The EG also had longer disease-free survival (DFS), overall survival (OS) and cancer-specific survival (CSS) compared to the YG, but these findings were not statistically significant (p>0.05). Old age was not an independent factor for DFS, OS and CSS by Cox multivariate regression analysis (p>0.05). Conclusions: Hepatectomy is safe for colorectal liver-limited metastases in elderly patients, and these patients may subsequently benefit from prolonged DFS, OS and CSS.

scholarly journals Long-Term Outcomes of Hepatic Resection versus Living Donor Liver Transplantation for Hepatocellular Carcinoma: A Propensity Score-Matching Study

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Toshimi Kaido ◽  
Satoshi Morita ◽  
Sachiko Tanaka ◽  
Kohei Ogawa ◽  
Akira Mori ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Propensity Score ◽  
Hepatic Resection ◽  
Propensity Score Matching ◽  
Odds Ratio ◽  
Living Donor ◽  
Survival Rates ◽  
Controlled Study ◽  
Recurrence Rates

Hepatic resection (HR) and liver transplantation (LT) are surgical treatment options for hepatocellular carcinoma (HCC). However, it is clinically impossible to perform a randomized, controlled study to determine the usefulness of these treatments. The present study compared survival rates and recurrence rates of HR versus living donor LT (LDLT) for HCC by using the propensity score method. Between January 1999 and August 2012, 936 patients (732 HR, 204 LDLT) underwent surgical therapy for HCC in our center. Using the propensity score matching, 80 well-balanced patients were defined. The 1- and 5-year overall survival rates were 90% and 53% in the HR group and 82% and 63% in the LT group, respectively. They were not significantly different between the two groups. The odds ratio estimated using the propensity score matching analysis was 0.842 (P=0.613). The 1- and 5-year recurrence rates were significantly lower in the LT group (9% and 21%) than in the HR group (43% and 74%) (P<0.001), and the odds ratio was 0.214 (P=0.001). In conclusion, HR should be considered a valid alternative to LDLT taking into consideration the risk for the living donor based on the results of this propensity score-matching study.

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