Abstract
BackgroundThe aim of this study was to identify predictors of mortality in elderly patients undergoing colorectal cancer surgery and to develop a risk score.MethodsThis was an observational prospective cohort study. Individuals over 80 years diagnosed with colorectal cancer and treated surgically were recruited in 18 hospitals in the Spanish National Health Service, between June 2010 and December 2012, and were followed up 1, 2, 3, and 5 years after surgery. Sociodemographic and clinical data were collected. The primary outcomes were mortality at 2 and between 2 and 5 years after the index admission.ResultsThe predictors of mortality 2 years after surgery were haemoglobin ≤ 10 g/dl and colon locations (HR 1.02; CI 0.51–2.02), ASA class of IV (HR 3.55; CI 1.91–6.58), residual tumour classification of R2 (HR 7.82; CI 3.11–19.62), TNM stage of III (HR 2.14; CI 1.23–3.72) or IV (HR 3.21; CI 1.47–7), LODDS of more than − 0.53 (HR 3.08; CI 1.62–5.86)) and complications during admission (HR 1.73; CI 1.07–2.80). Between 2 and 5 years of follow-up, the predictors were no tests performed within the first year of follow-up (HR 2.58; CI 1.21–5.46), any complication due to the treatment within the 2 years of follow-up (HR 2.47; CI 1.27–4.81), being between 85 and 89 and not having radiotherapy within the second year of follow-up (HR 1.60; CI 1.01–2.55), no colostomy closure within the 2 years of follow-up (HR 4.93; CI 1.48–16.41), medical complications (HR 1.61; CI 1.06–2.44), tumour recurrence within the 2 years of follow-up period (HR 3.19; CI 1.96–5.18), and readmissions at 1 or 2 years of follow-up after surgery (HR 1.44; CI 0.86–2.41).ConclusionWe have identified variables that, in our sample, predict mortality 2 and between 2 and 5 years after surgery for colorectal cancer older patients. We have also created risks scores, which could support the decision-making process.Trial registrationClinicalTrials.gov, NCT02488161.
Highlights
Populations are ageing all around the world
Materials & methods The data presented in this manuscript is a post hoc analysis that comes from a prospective observational cohort study that recruited patients diagnosed with colorectal cancer who were treated surgically
The inclusion criteria were that patients were diagnosed with cancer of the colon or rectum, had curative or palliative surgery performed for first time, and signed the informed consent form to participate in the study
Summary
Populations are ageing all around the world. In Spain, in 2016, 18% of the population was over 60 years, with octogenarians representing 6% of the total, and these percentages will grow in the coming years [1].Cancer is one of the main causes of morbidity and mortality worldwide, with 18 million new cases and 9.6 million deaths in 2018 [2]. Populations are ageing all around the world. In Spain, in 2016, 18% of the population was over 60 years, with octogenarians representing 6% of the total, and these percentages will grow in the coming years [1]. Cancer is one of the main causes of morbidity and mortality worldwide, with 18 million new cases and 9.6 million deaths in 2018 [2]. Colorectal cancer was the most frequent cancer, with 1.8 million new cases and almost 861,000 deaths [2]. As for the incidence of cancer in the elderly, a review stated that it is 11-fold compared with younger patients [3]. There is an increase in the average age at the time of cancer diagnosis. The aim of this study was to identify predictors of mortality in elderly patients undergoing colorectal cancer surgery and to develop a risk score
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