Colorectal Cancer In Older Patients Research Articles

The short-term and oncologic outcomes of younger VS older colorectal cancer patients undergoing primary surgery: a propensity score matching analysis

PurposeThe purpose of the current study is to analyze the difference of short-term and oncologic outcomes between younger and older colorectal cancer (CRC) patients who underwent primary CRC surgery using a propensity score matching (PSM) analysis.MethodsWe retrospectively collected CRC patients who underwent primary surgery in a single clinical database from Jan 2011 to Jan 2020. The short-term and oncologic outcomes were compared between younger aged group and older aged group.ResultsA total of 4599 patients were included in this study, and there were 4196 patients in older aged group and 403 patients in younger aged group. After 1:1 ratio PSM, there were 401 patients in each group. No significant difference was found in terms of baseline information after PSM (p>0.05). Younger aged group had larger retrieved lymph nodes before (p<0.001) and after PSM (p=0.001) than older aged group. In multivariate analysis, younger age was an independent predictor of better overall survival (OS) (p<0.001, HR=2.303, 95% CI=1.658-3.199) and disease-free survival (DFS) (p=0.008, HR=1.425, 95% CI=1.098-1.850). In terms of different tumor stage after PSM, younger aged group had better OS than older group in stage II (p<0.001) and stage IV (p=0.028) CRC, and younger aged group had better DFS than older group in stage II (p=0.016) CRC.ConclusionYounger CRC patients had larger retrieved lymph nodes and better prognosis than older CRC patients after primary CRC surgery.

Impact of COVID-19 pandemic on gastrointestinal cancer diagnosis and resection: An observational study

BackgroundThe COVID-19 pandemic disrupted routine screening for and treatment of gastrointestinal (GI) cancers. We analyzed changes in GI cancer pathology specimens resulting from diagnostic and therapeutic procedures at a single academic center in an epicenter of the COVID-19 pandemic. Our aim was to determine which cancer types, procedures, and patients were impacted by the pandemic. MethodsThis was a retrospective, cohort study of patients identified based on carcinoma containing pathologic specimens reviewed in our institution resulting from diagnostic or resection procedures. Pathology and medical records of patients with GI and liver carcinoma and high-grade dysplasia were reviewed from February 1 to April 30 in 2018, 2019 and 2020. We used March 16, 2020 to delineate the pre-COVID-19 and COVID-19 period in 2020. Chi-squared or t-tests, as appropriate, were used to compare these time periods in each year. Mann Kendall test was used to test for trend in volume. ANCOVA was used to compare differences across years. ResultsA total of 1028 pathology samples from 949 unique patients were identified during the study period. There was a 57% drop in samples within 2020 (p = 0.01) that was not present in either 2018 or 2019 (p<0.01). In 2020, there were significantly fewer resections compared to biopsies overall in the COVID-19 period (p = 0.01). There were fewer colorectal cancer specimens (p = 0.04) which were procured from older patients (p<0.01) in the 2020 COVID-19 period compared to pre-COVID-19. ConclusionsIn our institution, there was a significant drop in diagnostic and resection specimens of GI cancers during the COVID-19 pandemic, disproportionately affecting older colorectal cancer patients.

Association of Comedication Quality With Chemotherapy-Related Adverse Drug Reactions and Survival in Older Colorectal Cancer Patients.

Evidence about the clinical relevance of appropriate comedication among older colorectal cancer (CRC) patients is sparse. A cohort study was conducted with 3239 CRC patients aged 65 years and older. To assess comedication quality, we calculated the total Fit fOR The Aged (FORTA) score and its subscores for medication overuse, underuse, and potentially inappropriate medication use. Multivariable Cox proportional hazards or logistic regression models were performed to evaluate the association of comedication quality with up to 5-year overall survival, CRC-specific survival, and chemotherapy-related adverse drug reactions. Overall, 3239 and 1209 participants were included in analyses on survival and adverse drug reactions, respectively. The hazard ratios [95% confidence intervals] for the total FORTA score ≥ 7 versus 0-1 points were 1.83 [1.40-2.40] and 1.76 [1.22-2.52] for up to 5-year overall and CRC-specific survival, respectively. Worse up to 5-year overall survival and CRC-specific survival was also evident for FORTA subscores for potentially inappropriate medication use and overuse, whereas no association was observed for underuse. Although results for the total FORTA and potentially inappropriate medication score were much stronger among patients receiving chemotherapy, no significant associations with chemotherapy-related adverse drug reactions were observed. Moreover, associations were particularly strong among men and rectal cancer patients as compared to women and colon cancer patients. Poor total comedication quality was significantly associated with worse up to 5-year overall and CRC-specific survival. Randomized controlled trials are needed to test whether improved cancer comedication management in older CRC patients prolongs survival.

The Impact of Diabetes Mellitus on the Second Primary Malignancies in Colorectal Cancer Patients

IntroductionAll colorectal cancer (CRC) survivors have an increased risk of developing second primary malignancies (SPMs). The association between diabetes mellitus (DM) and the risk of cancer is well known. However, the role of DM and its therapy in the development of SPMs in CRC patients is not well described.MethodsIn this single-institutional retrospective analysis we identified 1,174 colorectal carcinoma patients, median follow-up 10.1 years, (median age 63 years, 724 men). All patients over 18 years with histologically confirmed CRC who were admitted in the period 1.1. 2003- 31.12.2013 and followed-up till 31.12. 2018 at the Masaryk Memorial Cancer Institute (MMCI) were screened for eligibility. The exclusion criteria were CRC diagnosed at autopsy, lost to follow-up and high risk of development of SPMs due to hereditary cancer syndrome. Tumours are considered multiple primary malignancies if arising in different sites and/or are of a different histology or morphology group. Comparisons of the basic characteristics between the patients with SPM and the patients without SPM were performed as well as comparison of the occurrence of SPMs by the site of diagnosis between the DM and non-DM cohorts and survival analyses.ResultsA SPM was diagnosed in 234 (20%) patients, DM in 183 (15%) patients. DM was diagnosed in 22.6% of those with SPM vs. in 13.8% of those without SPM (p=0.001). The most common types of SPMs in DM patients were other CRC, kidney, lung, bladder and nonmelanoma skin cancer, but only carcinoma of the liver and bile duct tracts was significantly more common than in the group without DM. Although breast cancer was the second most common in the group with DM, its incidence was lower than in the group without DM, as well as prostate cancer. A significantly higher incidence of SPMs was found in older CRC patients (≥ 65 years) and in those with lower stage colon cancer and DM. No significant difference in DM treatment between those with and without a SPM was observed including analysis of type of insulin.ConclusionCRC patients with diabetes mellitus, especially those with older age, and early stages of colon cancer, should be screened for second primary malignancies more often than the standard population. Patients without DM have longer survival. According to the occurrence of the most common second malignancies, a clinical examination, blood count, and ultrasound of the abdomen is appropriate, together with standard breast and colorectal cancer screening, and lung cancer screening under certain conditions, and should be recommended in CRC survivors especially in patients with intercurrent DM, however the necessary frequency of screening remains unclear.

Racial disparities negatively impact outcomes for patients with early-onset colorectal cancer independent of income or education status.

20 Background: The incidence of colorectal cancer (CRC) in patients under age 50 is rising for reasons that are incompletely understood. We examined the effects of health disparities and socioeconomic factors on outcomes for patients with early-onset CRC compared to older-onset CRC. Methods: Patients with CRC from 2004-2015 in the National Cancer Database were included and categorized by age under or over 50 years. Differences in demographic, disease and treatment characteristics and socioeconomic factors between younger and older patients were assessed by Chi-square test. The effect of age, race, ethnicity, insurance status, community median income and community educational attainment on overall survival (OS) were assessed using Cox models. Subgroup analyses were carried out by factors with significant interactions with race. Bonferonni correction was used when indicated. Results: The study population comprised 1,061,204 patients, 108,058 (10.2%) of whom were under age 50. The proportion of patients diagnosed under age 50 increased over time: 9.4% in 2004-2006, 10.1% in 2007-2009, 10.5% in 2010-2012 and 10.7% in 2013-2015. Compared to older patients, young patients were more likely to be Black (15.1% vs. 11.3%) or Hispanic (8.6% vs. 4.6%) and to be diagnosed with stage 4 disease (24.9% vs. 17.0%), p &lt; 0.0001 for all. Age &lt; 50 years was associated with improved median OS (157.4 vs. 64.2 months, p &lt; 0.0001). ). Black patients had the worst median OS (58.3 months) compared to White (67.0 months), Hispanic (91.6 months) or Asian (104.9 months) patients, p &lt; 0.0001. Within the subgroup of early-onset CRC patients with private insurance, Blacks had worse OS compared to White patients at multiple community income and education levels. Older CRC patients did not demonstrate the same disparities. Asian and Hispanic patients had equivalent or better OS compared to White patients regardless of insurance type, income or education level. These data are shown in the Table. Conclusions: Early-onset CRC continues to increase. Patients with early-onset CRC are more likely to be Black or Hispanic and to present with stage 4 cancer compared to older patients. Alarmingly, Black patients showed worse OS compared to White patients in all income subgroups, even with private insurance. Much more work is needed to address the environmental factors and health disparities that lead to these outcomes. [Table: see text]

Frailty screening by Geriatric-8 and 4-meter gait speed test is feasible and predicts postoperative complications in elderly colorectal cancer patients

IntroductionIdentification of frail older colorectal cancer patients might help to select those prone to adverse events and may lead to adjustment of treatment plans. However, the prognostic validity of screening for frailty is unknown. MethodsThis retrospective study evaluates colorectal cancer patients ≥70 years who underwent elective surgery between May 2016 and December 2018. The Geriatric-8 (G8) and 4-m gait speed test (4MGST) were used as frailty screening tools. According to hospital guidelines, patients were referred to a geriatrician when screening was indicative for frailty (G8 ≤ 14 and/or 4MGST < 1 m/s). Patients were categorized as fit, vulnerable or frail by comprehensive geriatric assessment (CGA). The clinical implications and prognostic validity of frailty screening and CGA were evaluated. Results149 patients were included, of whom 132 (89%) were screened for frailty. Frailty was suspected in 40% of screened patients (n = 53) of whom 89% (n = 47) was referred for CGA. A higher complication rate was seen in patients with G8 ≤ 14 and/or 4MGST < 1 m/s compared to those with G8 > 14 and 4MGST ≥1 m/s (respectively 62% versus 28%,p < 0.001). Pneumonia (21% versus 6%, p = 0.013) and cardiac complications (11% versus 4%, p = 0.093) were more prevalent in patients with G8 ≤ 14 and/or 4MGST < 1 m/s. CGA identified frail patients as a group with a high complication rate of 68%. ConclusionScreening for frailty with subsequent referral for CGA is feasible in older colorectal cancer patients. Our study suggests that screening for frailty by G8 + 4MGST can identify patients with higher risk for postoperative complications.

Racial/ethnic disparities in colorectal cancer treatment utilization and phase-specific costs, 2000-2014.

BackgroundOur study analyzed disparities in utilization and phase-specific costs of care among older colorectal cancer patients in the United States. We also estimated the phase-specific costs by cancer type, stage at diagnosis, and treatment modality.MethodsWe used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify patients aged 66 or older diagnosed with colon or rectal cancer between 2000–2013, with follow-up to death or December 31, 2014. We divided the patient’s experience into separate phases of care: staging or surgery, initial, continuing, and terminal. We calculated total, cancer-attributable, and patient-liability costs. We fit logistic regression models to determine predictors of treatment receipt and fit linear regression models to determine relative costs. All costs are reported in 2019 US dollars.ResultsOur cohort included 90,023 colon cancer patients and 25,581 rectal cancer patients. After controlling for patient and clinical characteristics, Non-Hispanic Blacks were less likely to receive treatment but were more likely to have higher cancer-attributable costs within different phases of care. Overall, in both the colon and rectal cancer cohorts, mean monthly cost estimates were highest in the terminal phase, next highest in the staging phase, decreased in the initial phase, and were lowest in the continuing phase.ConclusionsRacial/ethnic disparities in treatment utilization and costs persist among colorectal cancer patients. Additionally, colorectal cancer costs are substantial and vary widely among stages and treatment modalities. This study provides information regarding cost and treatment disparities that can be used to guide clinical interventions and future resource allocation to reduce colorectal cancer burden.

Treatment guidelines of metastatic colorectal cancer in older patients from the French Society of Geriatric Oncology (SoFOG)

BackgroundSeveral guidelines dedicated to metastatic colorectal cancer (mCRC) are available. Since 2013 no recent guidelines are specifically dedicated to older patients and based on a systematic review. Materials and methodsA multidisciplinary Task Force with digestive oncologists, geriatricians and methodologists from the SoFOG was formed in 2016 to update recommendations on medical treatment of mCRC based on a systematic review of publications from 2000 to 2018. Search strategy has followed a standardized protocol from the formulation of clinical questions and definition of a search algorithm to the selection of complete articles for recommendations. ResultsThe four selected key questions were: For which older patients with mCRC can we considered: (1) Any chemotherapy, (2) Mono or poly-chemotherapy, (3) Anti-angiogenic therapy, (4) Other targeted therapy. Main recommendations for older patients are: (1) Omission of chemotherapy should be discussed with a geriatrician for patients with severe comorbidities, advanced dementia, uncontrolled psychiatric disorder or severe loss of autonomy. (2) If tumor response is not the main aim, a mono-chemotherapy with 5-fluorouracil combined with bevacizumab is recommended as first-line. (3) For patients with symptoms related to metastases or with a planned metastasis ablation, a doublet chemotherapy combined with bevacizumab or anti-EGFR antibody in the context of a RAS wild type tumor is recommended as first-line. Preliminary data suggest that regorafenib may be used, in its registered indication, in patients under 80 with a performance status of 0 and no autonomy alterations and that trifluridine-tipiracil may be used with a tight supervising of hematological function.

One-year conditional survival in surgically treated older colorectal cancer patients: a EURECCA European comparison

Background: With the ageing population, the number of older colorectal cancer patients is expected to increase. Older patients may have more comorbidities, frailty and increased impact of complication that can influence treatment decisions and survival. Previously, it has been demonstrated that after surviving the first year, older patients have the same cancer-related survival as younger patients. The present study aims to make European comparison of conditional one-year relative survival.

Physical performance has a strong association with poor surgical outcome in older patients with colorectal cancer

BackgroundLow lumbar skeletal muscle mass and density have been associated with adverse outcomes in different populations with colorectal cancer (CRC). We aimed to determine whether skeletal muscle mass, density, and physical performance are associated with postoperative complications and overall survival (OS) in older CRC patients. MethodsWe analysed consecutive patients (≥70 years) undergoing elective surgery for non-metastatic CRC (stage I-III). Lumbar skeletal muscle mass and muscle density were measured using abdominal CT-images obtained prior to surgery. Low skeletal muscle mass and low muscle density were defined using commonly used thresholds and by gender-specific quartiles (Q). The preoperative use of a mobility aid served as a marker for physical performance. Cox regression proportional hazard models were used to investigate the association between the independent variables and OS. Results174 Patients were included (mean age 78.0), with median follow-up 2.6 years. 36 Patients (21%) used a mobility aid preoperatively. Low muscle density (Q1 vs Q4) and not muscle mass was associated with worse postoperative outcomes, including severe complications (p < 0.05). Use of a mobility aid was associated with more complications, including severe complications (39% vs 17%, p = 0.004) and OS (HR 2.65, CI 1.29–5.44, p = 0.01). However, patients with mobility aid use and low skeletal muscle mass had worse OS (HR 5.68, p = 0.003). ConclusionLow skeletal muscle density and not muscle mass was associated with more complications after colorectal surgery in older patients. Physical performance has the strongest association for poor surgical outcomes and should be investigated when measuring skeletal muscle mass and density.

Is Colorectal Cancer in Patients Younger Than 50 Years of Age the Same Disease as in Older Patients?

The incidence of colorectal cancer (CRC) has declined steadily in persons over age 50 years of age, largely due to screening. In contrast, incidence rates have increased rapidly in younger adults (<50 years of age),1 raising the question of whether young-onset CRC is a distinct disease with unique biologic features or if it is the same disease occurring at a younger age. Studies comparing younger and older patients diagnosed with CRC have reported differences in clinical and molecular features, including tumor location, stage, and histology.2-6 However, increasing use of screening colonoscopy in the population has changed characteristics of CRC diagnosed over 50 years of age (eg, higher proportion now diagnosed with proximal tumors and/or at an earlier stage),7 so it is challenging to draw conclusions about the importance of these findings. To address this challenge, we compared characteristics of younger and older CRC patients in a predominantly unscreened population.

Why focus on patient-reported outcome measures in older colorectal cancer patients?

Colorectal cancer is the most common cancer among older persons, with surgery the recommended treatment for many. With a growing emphasis on value-based care, there is an increasing desire to implement patient-reported outcome measures. Patient-reported outcome measures (PROMs) are the tools and instruments used to collect patient-reported symptoms, functional status, and quality of life. Monitoring and addressing PROMs has been shown to improve patient-centered care in surgical oncology populations and survival in patients with advanced cancer. For older patients, functional status and quality of life are valuable outcomes of cancer treatment. However, experience with PROMs for older patients, and specifically older colorectal cancer patients, is limited and heterogenous. The International Consortium for Health Outcomes Measurement has recommended a set of outcome measures for colorectal cancer patients and a set of outcome measures for older patients, which have considerable overlap, providing a starting point for future investigations of PROMs for older colorectal cancer patients. While many questions remain, it is imperative that PROMs for older colorectal cancer patients be considered for their potential to improve cancer outcomes in this population.

Clinical and Genetic Characteristics of Colorectal Cancer in Persons under 50 Years of Age: A Review.

The incidence of colorectal cancer (CRC) in persons under the age of 50years (EOCRC) is increasing even as the incidence of CRC in persons over age 50 is decreasing. This has led to recommendations to lower the age of CRC screening to age 45. It is not clear whether EOCRC is identical to CRCs in older patients or whether there are distinctive features between the two groups. We reviewed the literature on the clinical and genetic aspects of EOCRC. We found that there is an increased likelihood of a strong genetic basis for EOCRC, but that at least 80% of cases do not come from the known high-penetrance cancer syndromes. Early-onset CRCs tend to occur in the distal colon or rectum, are more likely to be detected due to cancer-related symptoms, appear to be increasing in whites more than non-whites on a population-wide analysis, and are more likely to present in an advanced stage of disease. There are some unique genetic features of EOCRC, including an increased proportion of tumors with LINE-1 hypomethylation, and combined chromosomal and microsatellite stability. EOCRC deserves additional attention because of the high number of life years at risk with EOCRC, and the implications for earlier CRC screening. Additional focus is needed on determining whether some cases of EOCRC have a unique mechanistic basis.

Post-Acute Care among Older Adults with Stage I to III Colorectal Cancer.

Little information is available on the long-term use of post-acute care among older patients with colorectal cancer (CRC), relative to individuals without cancer. This study examines the use of post-acute care among older cancer survivors (>65 y) with CRC and compares it with noncancer patients up to 5 years from surgery. Retrospective cohort. SEER-Medicare. Patients treated for stage I to III CRC between January 1, 2000, and December 31, 2011 (n = 40 812) and noncancer Medicare beneficiaries hospitalized for noncancer treatment matching on age, sex, race, comorbidity, and Medicaid dual eligibility. Incident post-acute care claims (skilled nursing, long-term care facility, and home health) from 0 to 100 days, 101 to 365 days, and 1 to 5 years from hospitalization. The median age was 77 years. All patients had surgery, 34% received chemotherapy, and 27% received surgery and adjuvant therapy. The cumulative incidence of any post-acute care within 100 days of hospitalization was 45.7% for stage III, 37.9% for stage I/II, and 39% for controls (p < .001). Within the CRC cohort only, the cumulative incidence of post-acute care was 2.9% (stage I/II) and 4.2% (stage III, p < .001) from 101 to 365 days and 15.8% (stage I/II) and 16.9% (stage III, p < .001) from 1 to 5 years. Increasing age, ostomies, and neoadjuvant or adjuvant therapy were associated with increased hazard of all post-acute patients within 100 days from hospitalization. From 1 to 5 years from diagnosis, adjuvant therapy was associated with greater exclusive home health care use. Survivorship planning among older CRC patients should include discussions of post-acute care following cancer therapy, even several years after treatment. J Am Geriatr Soc 67:937-944, 2019.

Post-discharge complications in frail older patients after surgery for colorectal cancer

BackgroundThe incidence of postoperative complications after colorectal cancer surgery varies between publications. Complications occurring after discharge from hospital are often not reported. The aims of this study were to investigate the proportion of frail older colorectal cancer patients who developed complications only after discharge, the severity of post-discharge complications, and the time point at which the most frequent complications occurred. MethodsPatients were included if they were 65 years and older, screened positively for frailty and were scheduled for colorectal cancer surgery. Included patients were followed prospectively both in hospital and after discharge for 30 days after surgery, and complications were graded according to the Clavien-Dindo classification. ResultsWe included 114 patients. Median age was 79 years. Twenty-two patients (19%) were discharged without complications, but developed complications after discharge. These patients had shorter length of stay (6.5 versus 10 days), were more often discharged to their own home without assistance, and had higher 5-year survival (76% vs 54%) than patients who developed complications in hospital. Post-discharge complications were most frequently grade II. The most common types of complications that occurred late in the postoperative course were urinary tract infections and superficial surgical site infections. ConclusionsComplications after colorectal cancer surgery in frail older patients frequently arise after discharge from hospital. Doctors should be aware of this and inform their patients. This is increasingly important as length of stay after surgery decreases. When complications are used as a quality measure, it should be clear whether only in-hospital complications are registered.

Age-related differences in gene expression in colorectal cancer (CRC).

654 Background: Colorectal cancer (CRC) in young patients is increasing in incidence and is associated with worse outcomes than CRC in older patients. While distinct molecular subtypes of CRC have been recently characterized, it is unclear whether there are molecular differences between the tumors of young and old patients. We sought to identify differences in gene expression of CRC between these two groups. Our discovery analysis identified a gene signature of several differentially expressed RNAs, from which we validated PEG10. The PEG10 gene on chromosome 7q21.3 has been implicated in liver, gallbladder, thyroid, and blood cancers, and is thought to play a role in cancer cell survival and regulation of apoptosis. In hepatocellular carcinoma, increased PEG10 expression has been associated with younger patient age. Methods: RNA sequencing data was obtained from The Cancer Genome Atlas (TCGA) and analyzed for differences in gene expression between patients ≤ 45 years old and those ≥ 65 years old. The identified differentially expressed genes were then validated with qPCR using human CRC tissue from patients ≤ 45 years old and those ≥ 65 years old. Results: RNA sequencing data from patients ≤ 45 years old (n = 29) and patients ≥ 65 years old (n = 299) identified seven genes with increased expression in younger patients: ZNF334 (log2 [fold change] = 2.30), DSC3 (1.78), PEG10 (1.67), CACNA1I (1.54), PKIA (1.33), MAP9 (1.27), and EPHX3 (1.17) (p &lt; 0.07). Validation with qPCR for PEG10 was most promising, and was performed on both young (n = 10, mean age = 39) and old patient samples ( n= 8, mean age = 72). Two cancers (20%) in the young group received radiation treatment and five (50%) received chemotherapy. One cancer (12.5%) in the old group received radiation and two (25%) received chemotherapy. PEG10 had increased expression in the young group with log2 [fold change] = 3.16 (p &lt; 0.02). Conclusions: We have identified a potentially unique gene expression signature for CRC in young patients, which includes PEG10. Functional analysis of PEG10 and other genes is underway using in vitro cell culture, archived human tumor tissue, and mouse tumor models.

Risk stratification for surgical outcomes in older colorectal cancer patients using ISAR-HP and G8 screening tools.

Older patients are at risk for adverse outcomes after surgical treatment of cancer. Identifying patients at risk could affect treatment decisions and prevent functional decline. Screening tools are available to select patients for Geriatric Assessment. Until now their predictive value for adverse outcomes in older colorectal cancer patients has not been investigated. To study the predictive value of the Geriatric 8 (G8) and Identification of Seniors at Risk for Hospitalized Patients (ISAR-HP) screening tools for adverse outcomes after elective colorectal surgery in patients older than 70years. Primary outcomes were 30-day complication rates, secondary outcomes were the length of hospital stay and six-month mortality. Multicentre cohort study from two hospitals in the Netherlands. Frail was defined as a G8 ≤14 and/or ISAR-HP ≥2. Odds ratio (OR) is given with 95% CI. Overall, 139 patients (52%) out of 268 patients were included; 32 patients (23%) were ISAR-HP-frail, 68 (50%) were G8-frail, 20 were frail on both screening tools. Median age was 77.7years. ISAR-HP frail patients were at risk for 30-day complications OR 2.4 (CI 1.1-5.4, p=0.03), readmission OR 3.4 (1.1-11.0), cardiopulmonary complications OR 5.9 (1.6-22.6), longer hospital stay (10.3 versus 8.9day) and six-months mortality OR 4.9 (1.1-23.4). When ISAR-HP and G8 were combined OR increased for readmission, 30-day and six-months mortality. G8 alone had no predictive value. ISAR-HP-frail patients are at risk for adverse outcomes after colorectal surgery. ISAR-HP combined with G8 has the strongest predictive value for complications and mortality. Patients screening frail on ISAR-HP are at increased risk for morbidity and mortality. Screening results of G8 alone was not predictive for postoperative outcomes. Predictive value increased when G8 and ISAR-HP were combined.

Comparison of Colonoscopy Surveillance Outcomes Between Young and Older Colorectal Cancer Patients.

BackgroundYoung-onset colorectal cancer is uncommon, but the incidence is increasing. Despite several guidelines for colonoscopic surveillance following colorectal cancer resection, there is little consistency regarding the timing and age-adjusted strategies of surveillance colonoscopy after surgery of young-onset colorectal cancer. The aim of this study was to compare the outcomes of surveillance colonoscopy between sporadic colorectal cancer patients with young and older age after curative resection.MethodsWe retrospectively reviewed 569 colorectal cancer patients who underwent curative resection between January 2006 and December 2010. The primary outcome was comparison of the development of metachronous advanced neoplasia during surveillance colonoscopy between young and older colorectal cancer patients.ResultsThere were 95 patients in the young age group and 474 patients in the older age group. The mean time interval from surgery to the development of metachronous advanced neoplasia was 99.2 ± 3.7 months in the young age group and 84.4 ± 2.5 months in the old age group (P = 0.03). In the multivariate analysis, age (OR, 3.56; P = 0.04) and family history of colorectal cancer (OR, 2.66; P = 0.008) were associated with the development of metachronous advanced neoplasia. None of the young patients without both family history of colorectal cancer and high-risk findings at index colonoscopy showed advanced neoplasia during the follow-up period.ConclusionsAge and family history of colorectal cancer are independent risk factors for the occurrence of advanced neoplasia after curative colorectal cancer resection, suggesting age-adjusted strategies of surveillance colonoscopy.

Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

Incidence of colorectal carcinoma following liver transplantation: A retrospective analysis using the United Network for Organ Sharing (UNOS) database.

542 Background: Since 1988, approximately 145,000 liver transplants (LT) have been performed in the United States, with 7,127 in 2015 alone. Several malignancies occur more frequently in solid organ transplant recipients. Studies have shown increased risk of Colorectal cancer (CRC) post LT in adults with primary sclerosing cholangitis, whether the risk of de novo CRC is increased or not remains controversial. Methods: A retrospective analysis was conducted using the UNOS database. Between-group differences in CRC rates were compared using Fisher’s exact test whereas, the differences in observed years between liver transplant and CRC were compared using negative binomial regression models. Results: We retrospectively analyzed 12,337 recipients of LT within the UNOS database. The overall incidence of CRC post LT was estimated to be at 3.8 percent. Interestingly, the incidence was higher in women and non-obese recipients. All immunosuppressive agents within the limits of the database were analysed for maintenance and anti-rejection. The two agents with some increase in incidence were cyclosporine and cellcept but this was statistically insignificant.(Table 1) Women and elderly ( &gt; 65 years) were likely to develop CRC approximately 25 percent earlier than men and younger patients (p = 0.003 and p = 0.001, respectively). Conclusions: Studies have shown a trend toward increased incidence of CRC post LT. These studies were limited by the sample size and were single-center trials. To date there are no elaborate guidelines on surveillance of CRC in LT recipients. In our study there was a shorter interval to development of CRC in older patients and women, suggesting that this population may benefit from early initiation of screening. [Table: see text]