Abstract
BackgroundWe aimed at determining the influence of old age on lymph node metastasis (LNM) and prognosis in T1 colorectal cancer (CRC).MethodsWe collected data from eligible patients in Surveillance, Epidemiology, and End Results database between 2004 and 2015. Independent predictors of LNM were identified by logistic regression analysis. Cox regression analysis, propensity score-matched analysis, and competing risks analysis were used to analyze the associations between old age and lymph node (LN) status and to validate the prognostic value of old age on cancer-specific survival (CSS).ResultsIn total, 10,092 patients were identified. Among them, 6,423 patients (63.6%) had greater than or equal to 12 examined lymph nodes (LNE ≥12), and 5,777 patients (57.7%) were 65 years or older. The observed rate of LNM was 4.6% (15 out of 325) in T1 CRC elderly patients, with tumor size <3 cm, well differentiated, with negative carcinoembryonic antigen (CEA) level, and adenocarcinoma. Logistic regression models demonstrated that tumor size ≥3 cm (odds ratio, OR = 1.316, P = 0.038), poorly differentiated (OR = 3.716, P < 0.001), older age (OR = 0.633 for ages 65–79 years, OR = 0.477 for age over 80 years, both P <0.001), and negative CEA level (OR = 0.71, P = 0.007) were independent prognostic factors. Cox regression analysis demonstrated that CSS was not significantly different between elderly patients undergoing radical resection with LNE ≥12 and those with LNE <12 (hazard ratio = 0.865, P = 0.153), which was firmly validated after a propensity score-matched analysis by a competing risks model.ConclusionsThe predictive value of tumor size, grading, primary site, histology, CEA level, and age for LNM should be considered in medical decision making about local resection. We found that tumor size was <3 cm, well differentiated, negative CEA level, and adenocarcinoma in elderly patients with T1 colorectal cancer which was suitable for local excision.
Highlights
Colorectal cancer (CRC) is among the most prevalent malignant tumors in most countries worldwide and ranks third in cancerassociated deaths in the United States [1, 2]
With the logistic regression model, propensity score-matching (PSM) analysis, and competing risks approach, in this study, we explored the predictors for Lymph node metastasis (LNM) and survival of elderly patients in T1 CRC by extracting eligible data from the Surveillance, Epidemiology, and End Results (SEER) database
The patients were eliminated if [1] they had distant metastasis, [2] they received adjuvant radiotherapy, [3] they had more than one type of malignancies, except those with CRC as the first diagnosed, [4] they had survival of less than 1 month, which was mostly caused by surgical complications, and [5] they only had a death certificate or were unaware whether an operation was conducted
Summary
Colorectal cancer (CRC) is among the most prevalent malignant tumors in most countries worldwide and ranks third in cancerassociated deaths in the United States [1, 2]. Lymph node metastasis (LNM) has been uncovered to range from 8 to 15% in T1 CRC [4]. Enhancing the number of sampled LNs during operation could not improve the survival of CRC patients 65 years and older [5]. Overtreatment in patients could cause harmful responses (including unnecessary biopsy, surgical resection, and other therapeutic interventions), in the elderly patients. For another thing, the incomplete removal of positive LNs could enhance the risk of a local recurrence, thereby leading to poor prognosis. We aimed at determining the influence of old age on lymph node metastasis (LNM) and prognosis in T1 colorectal cancer (CRC)
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