Survival Outcomes In Elderly Patients Research Articles

Clinical characteristics and survival outcomes of elderly patients with de novo metastatic germ cell tumors.

To determine the outcomes for elderly patients with de novo metastatic germ cell tumors and the influence of patient age on adherence to standard chemotherapy. A total of 150 patients who were initially diagnosed with metastatic germ cell tumors and treated at our institution between 2007 and 2021 were included. Patients were classified according to three age groups: aged <40, 40-49, and ≥50 years. Clinicopathological features, adherence to standard first-line chemotherapy, overall survival, and disease-free survival were compared between these groups. We also analyzed the outcomes of patients who received low-intensity induction chemotherapy due to adverse events and/or comorbidities. There was no significant difference in any of the survival outcomes and in the rate of adherence to standard first-line chemotherapy between the three age groups, although elderly patients with intermediate/poor prognosis group tended to receive less-intense chemotherapies. The rate of febrile neutropenia as a chemotherapy-related adverse event was significantly higher in patients aged ≥50 years. No statistical significance in survival outcomes was detected between the group of patients who received relatively low-intensity induction chemotherapy and those who received adequately intensive planned chemotherapy. The adherence rate of standard fist-line chemotherapy of elderly patients is almost comparable to that of younger patients, although some adverse events should be carefully managed. Even elderly patients with metastatic germ cell tumors can aim for equivalently good survival outcome like younger populations, with effort to adhere to standard chemotherapy.

145 Survival outcomes of elderly patients treated with a curatively-intended treatment for HPV-related oropharyngeal cancer: a multicenter cohort study

145 Survival outcomes of elderly patients treated with a curatively-intended treatment for HPV-related oropharyngeal cancer: a multicenter cohort study

Gross total resection and survival outcomes in elderly patients with spinal chordoma: a SEER-based analysis.

The association between aggressive resection and improved survival for adult spinal chordoma patients has not been well characterized in the geriatric population. Thus, the present study aimed to elucidate the relationship between gross total resection (GTR) and survival outcomes for patients across different age groups. The authors isolated all adult patients diagnosed with spinal chordoma from the 2000-2019 Surveillance, Epidemiology, and End Results database and divided patients into three surgical subgroups: no surgery, subtotal resection (STR), and GTR. Kaplan-Meier curves with a log-rank test were used to discern differences in overall survival (OS) between surgical subgroups. Univariate and multivariate analyses were used to identify prognostic factors of mortality. There were 771 eligible patients: 227 (29.4%) received no surgery, 267 (34.6%) received STR, and 277 (35.9%) received GTR. Patients receiving no surgery had the lowest 5-year OS (45.2%), 10-year OS (17.6%), and mean OS (72.1 months). After stratifying patients by age, our multivariate analysis demonstrated that patients receiving GTR aged 40-59 (HR=0.26, CI=0.12-0.55, p<0.001), 60-79 (HR=0.51, CI=0.32-0.82, p=0.005), and 80-99 (HR=0.14, CI=0.05-0.37, p<0.001) had a lower risk of mortality compared to patients undergoing no surgery. The frequency of receiving GTR also decreased as a function of age (16.4% [80-99 years] vs. 43.2% [20-39 years]; p<0.001), but the frequency of receiving radiotherapy was comparable across all age groups (48.3% [80-99 years] vs. 45.5% [20-39 years]; p=0.762). GTR is associated with improved survival for middle-aged and elderly patients with spinal chordoma. Therefore, patients should not be excluded from aggressive resection on the basis of age alone. Rather, the decision to pursue surgery should be decided on an individual basis.

A Comprehensive Model for Predicting 1-Year Survival after Allogeneic Hematopoietic Cell Transplantation in Older Patients

Background: As the number of elderly patients referred to and undergoing allogeneic hematopoietic cell transplantation (alloHCT) continues to rise, there is a growing need for a comprehensive risk assessment model to accurately predict transplantation outcomes in this specific patient population. The widely used Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) does not fully capture factors influencing transplant outcomes in elderly patients. This study aims to enhance risk stratification for elderly patients undergoing alloHCT by integrating additional functional, nutritional, and clinical indicators. Methods: This is a retrospective study utilizing the data registry of HCT patients who received their treatment at UF Health Cancer Center. The inclusion criteria included all patients age &amp;gt; 65 years, who underwent their first alloHSCT between January 2012 and December 2022, regardless of graft type, conditioning regimen, donor type, or graft source. Patient data were extracted through chart review. The primary endpoint was 1-year Overall Survival (OS). Prognostic significance of each variable was assessed using Cox proportional hazard models. We subsequently used all variables to build a comprehensive prediction model to assess 1-year survival outcomes in elderly patients undergoing alloHCT. The predictive model's performance was measured by the Concordance-statistic (c-statistic). Results: A total of 69 patients satisfied the inclusion criteria and were included in the analysis. Median age was 69 years (range 66-81) and 65.2% were male. Unrelated donors were used in 66.6% of patients, while the remainder received grafts from related donors. Most patients received peripheral blood stem cell grafts (91%). Myeloid malignancies comprised the most common indication for alloHCT in this group of patients (89.8%). 59.4% had abnormal cytogenetics. 35 variables were considered in the analysis. In the univariate analysis, variables with impact on 1-year OS post-transplant included creatinine (HR 3.35, CI 1.62-6.91, p=0.001), blood urea nitrogen (HR 1.03, CI 1.01-1.06, p=0.007), estimated glomerular filtration rate (HR 0.93, CI 0.89-0.93, p=0.001), hemoglobin (HR 0.8, CI 0.66-0.97, p=0.02), abnormal cytogenetics (HR 2.27, CI 1.20-4.31, p=0.012) and high and very high disease risk index (HR 0.51, CI 0.27-0.98, p=0.04). Notably, both hemoglobin and cytogenetics demonstrated a c-statistic greater than 0.6 in the univariate analysis. In the multivariate analysis, variables impacting 1-year OS included hemoglobin (HR 0.69, CI 0.48-0.99, p=0.04), remission status at the time of transplant i.e., not reached (NR) vs complete remission 1 (CR1) (HR 0.05, CI 0.00-0.71, p=0.027), and abnormal cytogenetics (HR 7.55, CI 2.32-24.58, p=0.001). Interestingly, the HCT-CI did not significantly impact 1-year OS in the univariate analysis (c-statistic 0.51, HR 0.99, CI 0.85-1.15, p=0.896). Our prediction model showed good performance with a mean area under the receiver operating characteristic curve of 0.82. Conclusion: We developed a comprehensive prediction model to assess 1-year OS in elderly patients undergoing alloHCT to overcome some of the limitations of the HCT-CI in this unique age group. This model holds potential to enhance decision-making regarding candidacy for elderly patients undergoing alloHCT.

Toxicity and Outcomes of Definitive Local Therapy in Elderly Patients with HPV-Associated Oropharyngeal Cancer

The incidence of human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma (HPV-OPSCC) has increased in elderly patients. It is unclear if survival outcomes in elderly patients are similar to those seen in younger patients with HPV-OPSCC. In this study we evaluated disease outcomes and toxicity in an elderly HPV-OPSCC population treated with curative-intent treatment of radiotherapy with or without chemotherapy. We performed a retrospective study of elderly patients (≥70 years old) with HPV-OPSCC treated between 2011-2021 with radiation therapy (RT) with or without chemotherapy. Time to event analysis for overall survival (OS), local control, and progression free survival (PFS) were estimated using the Kaplan-Meier method. Univariate and multivariate Cox regression models were used to estimate the hazard ratio associated with the covariates. We identified 77 elderly HPV-OPSCC patients, of which 60 (78%) were treated with concurrent chemotherapy. Twenty (26%) received concurrent Carboplatin and Taxol, 16 (21%) received Cetuximab, 14 (18%) received Cisplatin,7 (9%) received Carboplatin alone, and 2 (2%) received immunotherapy (Pembrolizumab or Nivolumab). The majority of patients received a radiation dose of 69.96 Gy or 70 Gy (89%). Forty-seven patients (61%) were stage I, 11 (14%) were stage II, 16 (21%) were Stage III, and 3 (4%) had stage IV disease. 50 patients (64%) were former smokers, 27 (35%) were nonsmokers and 1 (1%) is a current smoker. 37 patients (48%) had a ≥10 pack year smoking history. The 5-year OS, LC, and PFS for the entire cohort was 61%, 94%, and 58%, respectively. On univariate analysis, ECOG performance status (HR 0.22, [CI 0.06-0.78], p = 0.019) and Charlson Comorbidity Index (CCI) (HR 1.33, [CI 1.06-1.69], p = 0.014) were significant predictors of OS. On multivariate analysis, only CCI (HR 1.34, [CI 1.02-1.77], p = 0.035) was a significant predictor of OS. The rate of long-term feeding tube dependency was 9%. Late toxicities include osteoradionecrosis in 4 patients (5%), aspiration in 3 patients (4%), and esophageal stricture in 2 patients (3%). Elderly HPV-OPSCC patients treated with definitive intent radiotherapy with or without chemotherapy have favorable disease outcomes with low rates of late toxicity. The Charlson-Comorbidity Index can identify a subset of patients who may have a prolonged OS, and therefore may benefit from more aggressive treatment.

A Multicenter Study of 239 Patients Aged Over 70 Years With Diffuse Large B-Cell Lymphoma in China

Background: Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive lymphoma subtype worldwide and occurs frequently in the elderly population. However, there are limited data on the clinical profiles of patients with DLBCL over 70 years of age. Our objective was to summarize the clinical characteristics, treatment strategies and survival outcomes of this population in China. Methods: This multicenter retrospective study was conducted in China from January 2012 to July 2020 to investigate the clinical characteristics and survival outcomes. A total of 239 patients with DLBCL aged over 70 years underwent pretreatment evaluations, treatment, and follow-up at local hospitals. The primary endpoints were the progression-free survival (PFS) and the overall survival (OS) rates at 2 years. Secondary endpoints included median PFS and OS, the estimated PFS and OS rates at 5 years, and adverse events during treatment. Results: With a median follow-up of 50 months (range, 1–102 months), the 2-year PFS and OS rates were 53.0% and 65.5%, respectively. The median PFS and OS were 42.1 and 96.4 months, respectively; and the estimated 5-year PFS and OS rates were 44.7% and 56.1%, respectively. Hematological toxicities were the most common adverse effects in this study, accounting for 90.4%; and leukopenia was the most frequently observed ≥ grade 3 event. Furthermore, we found that regimens without rituximab and chemotherapy cycles < 6 were significantly associated with worse survival. Additionally, in the 70–80-year group, reduction in chemotherapy dose was associated with a significantly shorter OS, with a 2-year OS rate of 74.4% in the full dose group, compared to 67.1% for the decreased-dose group (p = 0.044). Conclusion: Our study presents the clinical profiles and survival outcomes of elderly patients with DLBCL in China. Treatment of these patients requires careful evaluation of toxicities and benefits. To this end, a prognosis model, such as comprehensive geriatric assessment, is required in clinical practice to optimally manage elderly patients with DLBCL.

Long-Term Survival Outcomes of Elderly Patients Treated With S-1 or Capecitabine Plus Oxaliplatin for Stage II or III Gastric Cancer: A Multicenter Cohort Study.

PurposeTegafur/gimeracil/oteracil (S-1) and capecitabine plus oxaliplatin (CAPOX) are standard adjuvant chemotherapies (ACs) administered after gastrectomy to patients with stage II or III gastric cancer. However, the efficacy of AC in elderly patients remains unclear. The objective of this retrospective multicenter cohort study was to compare the efficacies of S-1 and CAPOX AC in patients aged ≥70 years.Materials and MethodsNine hundred eighty-three patients who were treated with AC using S-1 (768 patients) or CAPOX (215 patients) were enrolled in this study. Each patient underwent AC after curative gastrectomy for stage II or III gastric cancer at one of 27 hospitals in the Republic of Korea between January 2012 and December 2013. Relapse-free survival (RFS) and overall survival (OS) were analyzed according to AC regimen and age group.ResultsOf the 983 patients, 254 (25.8%) were elderly. This group had a similar RFS (P=0.099) but significantly poorer OS (p=0.003) compared with the non-elderly group. Subgroup analysis of the non-elderly group revealed no AC-associated differences in survival. Subgroup analysis of the elderly group revealed significantly better survival in the S-1 group than in the CAPOX group (RFS, P<0.001; OS, P<0.001). Multivariate analysis revealed that the CAPOX regimen was an independent poor prognostic factor for RFS (hazard ratio [HR], 1.891; 95% confidence interval [CI], 1.072–3.333; P=0.028) and OS (HR, 2.970; 95% CI, 1.550–5.692; P=0.001).ConclusionsThis multicenter observational cohort study found significant differences in RFS and OS between S-1 and CAPOX AC among patients with gastric cancer aged ≥70 years.

Patterns of metastasis and prognosis of elderly esophageal squamous cell carcinoma patients in stage IVB: a population-based study.

BackgroundEsophageal squamous cell carcinoma (ESCC) has been listed among the most common esophageal cancers (ECs). Patients are generally relatively old in terms of their age at diagnosis of ESCC. A retrospective, population-based study appraising 537 elderly ESCC patients who suffered distant metastasis (DM) in stage IVB from 2010 to 2016 was performed. To this end, data pertaining to Surveillance, Epidemiology, and End Results (SEER) were adopted.MethodsA total of 537 elderly patients with IVB-stage ESCC suffering DM treated from 2010 to 2016 were taken as subjects. Prognosis was determined by using Kaplan-Meier analysis, as well as univariate and multivariate Cox regression. In accordance with sites of metastasis, these patients were classified into five groups: bone-, lung-, brain-, liver-only, and multiple-site (metastases to two or more organs) groups. In order to assess the prognosis, the cancer-specific survival (CSS), median survival time (MST), overall survival (OS), and survival rate (SR) were examined.ResultsThe lung was found to be the organ most vulnerable to metastasis in the population with single-organ metastasis, and liver, bone and brain followed in descending rank order. Relative to the group only having bone metastasis, the multiple-site group had the lowest CSS (HR: 1.067; 95% CI: 0.767–1.485; P=0.700) and OS (HR: 1.051; 95% CI: 0.759–1.454; P=0.766). The MST (MST: both 2 months in CSS and OS) and SR (6-month SR: 28.2% in CSS, 27.7% in OS; 1-year SR: 7.5% in CSS, 6.7% in OS; 3-year SR: 2.5% in CSS, 1.5% in OS) were also found to be the lowest for the multiple-site group among the total population. These patients benefited from treatment with chemotherapy (C), radiotherapy (R), and surgery (S), as evinced by the prognosis (CSS and OS: P<0.001), in comparisons with untreated patients (N) in the total population. The S or/and R + C resulted in no statistically significant differences to C alone (CSS: P=0.593; OS: P=0.510) in terms of the prognostic results, which indicated that C alone can have almost the same prognostic effect as multimodal therapy.ConclusionsPopulation-based research was used to determine patterns of metastasis and survival outcomes of elderly patients with IVB-stage ESCC suffering DM. The worst CSS and OS were found in patients with multiple-site metastasis across all groups. The treatment is an independent prognostic factor affecting prognosis. Chemotherapy plays a vital role in prognosis. Active therapies are beneficial to elderly patients with IVB-stage ESCC suffering DM, particularly chemotherapy.

Survival impact of concurrent chemoradiotherapy for elderly patients with synchronous oligometastatic esophageal squamous cell carcinoma: A propensity score matching and landmark analyses

PurposeTo evaluate the potential benefits of concurrent chemoradiotherapy (CCRT), and to establish a nomogram for predicting survival outcomes of elderly patients with synchronous oligometastatic esophageal squamous cell carcinoma (SOEC). Materials and methodsThis study eventually enrolled 314 elderly patients who initially diagnosed with SOEC from two centers. Treatment responses and outcomes of 151 patients receiving CCRT and 163 patients undergoing chemotherapy alone (CT) were compared. Propensity score matching and landmark analyses were performed to control potential confounding factors. A nomogram was established on the basis of the Cox regression model. ResultsAfter a median follow-up of 42.3 months, CCRT was superior to CT alone in objective response rate (ORR, 59.6% vs. 39.9%, P < 0.001), median progression-free survival (PFS, 10.0 vs. 7.2 months, P < 0.001), and median overall survival (OS, 18.5 vs. 15.6 months, P < 0.001). The propensity score matching (PSM) and landmark analyses redemonstrated the same trend (P < 0.01). On hierarchical analysis, patients with 1–3 metastatic lesions involving one organ displayed longer median PFS (9.0 vs. 7.8 months, P = 0.008) and OS (17.8 vs. 15.2 months, P < 0.001) than those with 4–5 metastatic lesions involving 2–3 organs. The major toxicities of grade III or higher for CCRT included leukocytopenia (23.2%), radiation esophagitis (7.3%), and radiation pneumonitis (8.6%). Cox multivariate analysis showed that the number of metastatic lesions (P = 0.012) and tumor response (P < 0.001) were independent prognostic factors associated with OS. A nomogram was established by incorporating the number of metastatic lesions and tumor response, with a concordance index of 0.743 after internal cross-validation. Calibration curves and decision curve analysis confirmed that nomogram had a favorable predictive value for individualized survival. ConclusionsCompared with CT alone, CCRT exhibited superior efficacy and acceptable toxicity in the first-line treatment for elderly patients with SOEC. The current study supports the oligometastatic definition of ≤3 metastatic lesions involving one organ for esophageal cancer patients. The constructed nomogram can effectively predict the individualized survival.

P10.02 Improved Survival of Elderly Patients with NSCLC Treated in the Immunotherapy Era: A Historical Cohort Study

Immune checkpoint inhibitors (ICI) have revolutionized the treatment of patients with non-small cell lung cancer (NSCLC). However, elderly patients are often under-represented in clinical trials, and the benefit of ICI in special populations remains unclear. This study aimed to evaluate treatment patterns and survival outcomes of elderly patients with NSCLC treated in the immunotherapy era compared to historical data.

Association of Systemic Inflammation and Overall Survival in Elderly Patients with Cancer Cachexia - Results from a Multicenter Study.

BackgroundSystemic inflammation and cachexia are associated with adverse clinical outcomes in elderly patients with cancer. The survival outcomes of elderly patients with cancer cachexia (EPCC) with high inflammation and a high risk of mortality are unknown. This study aimed to investigate the impact of high inflammation on the prognosis of EPCC patients with high mortality.Patients and MethodsThis multicenter cohort study included 746 EPCC (age >65 years) with a mean age of 72.00 ± 5.24 years, of whom 489 (65.5%) were male. The cut-off value for the inflammation index was obtained using the optimal survival curve. The different inflammatory indicators were assessed using the concordance index (C-index), decision curve analysis (DCA), and prognostic receiver operating characteristic (ROC). The high mortality risk group of EPCC was defined by the 2011 Fearon Cancer Diagnostic Consensus. EPCC were divided into the high-risk group, which satisfies three diagnostic criteria, and a low-risk group, which satisfies only one or two diagnostic criteria.ResultsThe C-index, DCA, and prognostic ROC indicated the superiority of advanced lung cancer inflammation index (ALI) compared with other indicators, including neutrophil–lymphocyte ratio (NLR), prognostic nutritional index (PNI), systemic immune-inflammation index (SII), and platelet–lymphocyte ratio (PLR). Whether ALI was used as a continuous or a categorical variable, ALI had a better prognostic value in EPCC compared with other inflammatory indicators. In particular, patients with low ALI (<25.03) had a worse overall survival (OS) than patients with high ALI (≥25.03) (P < 0.001, HR [95% CI] = 2.092 [1.590–2.751]). The combination effect analysis showed that the risk of mortality of the patients in the low-ALI and high-risk groups was 3.095-fold higher than that of patients in the high-ALI and low-risk groups.ConclusionThe prognostic and discriminative value of the inflammatory indicator ALI was better than that of NLR, PNI, SII, and PLR in EPCC. The high-risk group of EPCC with a low ALI would increase the death risk of OS.

MP48-05 NEOADJUVANT CHEMOTHERAPY IN ELDERLY PATIENTS WITH UPPER TRACT UROTHELIAL CANCER: ONCOLOGIC OUTCOMES FROM A MULTICENTER STUDY

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II (MP48)1 Sep 2021MP48-05 NEOADJUVANT CHEMOTHERAPY IN ELDERLY PATIENTS WITH UPPER TRACT UROTHELIAL CANCER: ONCOLOGIC OUTCOMES FROM A MULTICENTER STUDY Nico C. Grossmann, Benjamin Pradere, David D'Andrea, Victor M. Schuettfort, Keiichiro Mori, Pawel Rajwa, Fahad Quhal, Ekaterina Laukhtina, Satoshi Katayama, Christian D. Fankhauser, Evanguelos Xylinas, Vitaly Margulis, Alberto Briganti, Pierre I. Karakiewicz, and Shahrokh F. Shariat Nico C. GrossmannNico C. Grossmann More articles by this author , Benjamin PradereBenjamin Pradere More articles by this author , David D'AndreaDavid D'Andrea More articles by this author , Victor M. SchuettfortVictor M. Schuettfort More articles by this author , Keiichiro MoriKeiichiro Mori More articles by this author , Pawel RajwaPawel Rajwa More articles by this author , Fahad QuhalFahad Quhal More articles by this author , Ekaterina LaukhtinaEkaterina Laukhtina More articles by this author , Satoshi KatayamaSatoshi Katayama More articles by this author , Christian D. FankhauserChristian D. Fankhauser More articles by this author , Evanguelos XylinasEvanguelos Xylinas More articles by this author , Vitaly MargulisVitaly Margulis More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author , and Shahrokh F. ShariatShahrokh F. Shariat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002074.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The highest incidence of upper tract urothelial carcinoma (UTUC) is between 70-90 years of age and neoadjuvant chemotherapy (NAC) before radical nephroureterectomy (RNU) has shown promising oncologic outcomes. Nevertheless, the outcomes in elderly patients have never been explored despite the high incidence of elderly in UTUC. The objective was to assess the impact of NAC on pathological response and its association with survival outcomes in elderly patients. METHODS: This multicenter, retrospective study included patients who were treated with NAC and RNU for clinically non-metastatic UTUC. The cohort was stratified into two groups according to median age. Patients received either platinum-based or non-platinum-based chemotherapies. The primary endpoint was pathologic responses defined as pathologic downstaging (<ypT1N0) and pathologic complete response (ypT0N0). Univariable and multivariable logistic and Cox regression analyses were performed to identify associations between age groups, treatment regimens, chemotherapy cycles and pathological response as well as survival outcomes. RESULTS: Among the overall cohort we included 170 patients who met inclusion criteria. The median age of the cohort was 68 years (IQR 62-73) and the elderly group (>68 years) included 77 patients. The median follow-up was 29 months (IQR 11-64). Sixty-eight patients (41%) received MVAC, 66 (40%) GC and 32 (19%) non-platinum chemotherapy. Pathological downstaging (pDS) and complete pathologic response (pCR) were similar between groups (51% vs. 48%; p=0.7 and 9.7% vs. 9.1%; p=0.9, in younger and elderly groups respectively). On multivariable analysis, MVAC was independently associated with pCR on multivariable analysis (OR 4.41, 95% CI: 1.19-19.3; p=0.04) and showed a higher rate of pCR (14%) compared to other regimens (p=0.037). Non-platinum chemotherapy revealed a low pCR rate of 3.1%. There were no differences is Kaplan-Meier analysis in recurrence-free survival (RFS) and cancer-specific survival (CSS) between groups. CONCLUSIONS: Elderly patients with high-risk UTUC eligible to NAC prior to RNU may benefit from this multimodal therapy as well as their younger counterparts. Despite the reluctance to provide systemic therapy in elderly patients, this option appears to be efficient and further studies are required to define the best candidates. Nevertheless, since mainly only elderly patients fit for platinum-based chemotherapy experienced pathologic response, ineligible patients may be proposed alternative therapeutic options. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e865-e865 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nico C. Grossmann More articles by this author Benjamin Pradere More articles by this author David D'Andrea More articles by this author Victor M. Schuettfort More articles by this author Keiichiro Mori More articles by this author Pawel Rajwa More articles by this author Fahad Quhal More articles by this author Ekaterina Laukhtina More articles by this author Satoshi Katayama More articles by this author Christian D. Fankhauser More articles by this author Evanguelos Xylinas More articles by this author Vitaly Margulis More articles by this author Alberto Briganti More articles by this author Pierre I. Karakiewicz More articles by this author Shahrokh F. 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Combined radiotherapy and chemotherapy versus radiotherapy alone in elderly patients with nasopharyngeal carcinoma: A SEER population-based study.

Currently, the impact of chemotherapy (CT) on survival outcomes in elderly patients with nasopharyngeal carcinoma (NPC) receiving radiation therapy (RT) remains controversial. This retrospective study aims to investigate survival outcomes in a cohort of elderly NPC patients receiving RT alone or together with CT.Clinical data on 529 NPC patients aged 65 years and older extracted from the Surveillance, Epidemiology, and End Results registry (2004–2015) was collected and retrospectively reviewed. In this cohort, 74 patients were treated with RT alone and 455 individuals received RT and CT. We used propensity score matching with a 1:3 ratio to identify correlations between patients based on 6 different variables. Kaplan–Meier analysis was used to evaluate overall (OS) and cancer-specific survival (CSS). The differences in OS and CSS between the 2 treatment groups were compared using the Log-rank test and Cox proportional hazards models.The estimated 5-year OS and CSS rates for all patients were 49.5% and 59.3%, respectively. The combination of RT and CT provided longer OS than RT alone (53.7% vs 36.9%, P = .002), while no significant difference was observed in CSS (61.8% vs 51.7%, P = .074) between the 2 groups. Moreover, multivariate analysis demonstrated that the combination of CT and RT correlated favorably with OS and CSS. Subgroup analyses showed that the combination of RT and CT correlated better with both OS and CSS in patients with stage T3 or N2 or stage III.Among NPC patients aged 65 years and older, treatment with RT and CT provided longer OS than RT alone. Furthermore, the combination of RT and CT showed a better correlation with OS and CSS in NPC patients with stage T3 or N2 or stage III.

Oncologic and survival outcomes in elderly patients with locally advanced rectal cancer receiving neoadjuvant chemoradiotherapy and total mesorectal excision.

The efficacy of the addition of neoadjuvant chemotherapy to neoadjuvant chemoradiotherapy and total mesorectal excision for locally advanced rectal cancer in elderly patients has not been established. A total of 3096 locally advanced rectal cancer patients who received neoadjuvant chemotherapy, along with neoadjuvant chemoradiotherapy and total mesorectal excision, with or without adjuvant chemotherapy, between January 2010 and December 2018, were studied retrospectively. Patients were divided into elderly (>75years) and younger (≤75years) groups, and propensity score matching was used to balance a potentially confounding clinical bias. Overall survival, cancer-specific survival, disease-free survival, distant metastasis-free survival and local recurrence-free survival rates for the two groups were compared. Hazard ratios (HR) with 95% confidence intervals (CI) for different clinicopathological variables were calculated to determine predictors of 3-year overall survival. Mean follow-up was 39.0 (range, 5-140) months. The overall 3-year overall survival, cancer-specific survival, disease-free survival, distant metastasis-free survival and locoregional relapse-free survival rates were 86.1, 87.6, 80.0, 82.4 and 95.4%, respectively. Only 3-year overall survival rates differed significantly between the elderly (77.2%) and younger (88.9%) groups (P=0.01). Cancer-specific survival, disease-free survival, distant metastasis-free survival and locoregional relapse-free survival rates did not differ significantly between the two groups. Significant negative independent prognostic factors for 3-year overall survival were age>75years (HR=2.016, 95% CI 1.157-23.511, P=0.01) and high pathologic TNM stage (yp stage III, P<0.001). For elderly locally advanced rectal cancer patients who have good health and performance status, the addition of neoadjuvant chemotherapy to neoadjuvant chemoradiotherapy and total mesorectal excision can result in disease-related survival rates and oncological outcomes similar to those experienced by younger patients. The decision to use this treatment approach in elderly patients should not be based solely on chronological age.

Effect of timing of surgical resection of primary hepatocellular carcinoma on survival outcomes in elderly patients and prediction of clinical models

BackgroundThe effect of time delay from diagnosis to surgery on the prognosis of elderly patients with liver cancer is not well known. We investigated the effect of surgical timing on the prognosis of elderly hepatocellular carcinoma patients undergoing surgical resection and constructed a Nomogram model to predict the overall survival of patients.MethodsA retrospective analysis was performed on elderly patients with primary liver cancer after hepatectomy from 2012 to 2018. The effect of surgical timing on the prognosis of elderly patients with liver cancer was analyzed using the cut-off times of 18 days, 30 days, and 60 days. Cox was used to analyze the independent influencing factors of overall survival in patients, and a prognostic model was constructed.Results A total of 232 elderly hepatocellular carcinoma patients who underwent hepatectomy were enrolled in this study. The cut-off times of 18, 30, and 60 days were used. The duration of surgery had no significant effect on overall survival. Body Mass Index, Child-Pugh classification, Tumor size Max, and Length of stay were independent influencing factors for overall survival in the elderly Liver cancer patients after surgery. These factors combined with Liver cirrhosis and Venous tumor emboli were incorporated into a Nomogram. The nomogram was validated using the clinical data of the study patients, and exhibited better prediction for 1-year, 3-year, and 5-year overall survival.ConclusionsWe demonstrated that the operative time has no significant effect on delayed operation in the elderly patients with hepatocellular carcinoma, and a moderate delay may benefit some patients. The constructed Nomogram model is a good predictor of overall survival in elderly patients with hepatectomy.

Survival outcomes of elderly patients referred to the lower gastrointestinal 2‐week wait service

AbstractAimThe benefit to elderly patients (≥80 years old) of referral to the resource‐intensive lower gastrointestinal 2‐week wait (LGI‐2WW) pathway is unknown. The aim of this study was to investigate the survival outcome of elderly patients referred to a LGI‐2WW service.MethodThis study comprised a retrospective analysis of a prospectively gathered database of patients referred to a single‐centre LGI‐2WW service and conformed to STROBE guidelines. The primary outcome was all‐cause mortality. Statistical analysis was performed with the chi‐square test and Kaplan–Meier survival curves compared with the generalized log‐rank test.ResultsA total of 10 155 patients referred to the LGI‐2WW service between 1 January 2015 and 31 December 2018 were analysed; median follow‐up was 37.0 months (range 0–66 months). Six hundred and ninety one cancers were diagnosed (6.8% detection rate); 551 (80%) of these were lower GI cancers (LGICas) [517 (75%) colorectal; 34 (5%) anal]. Forty per cent of LGICas were diagnosed via the LGI‐2WW service. Patients aged ≥80 years with LGICa were more likely to be treated with palliative intent [age &lt;80 years, 92/360 (26%) vs. age ≥80 years, 105/191 (55%); p &lt; 0.001]. LGICa patients aged &lt;85 years had a survival difference between those treated with curative intent (LGICa‐Cur) or palliative intent (LGICa‐Pal) (median survival for patients aged 80–84 years: LGICa‐Cur 57 months vs. LGICa‐Pal 15 months; p &lt; 0.001). Patients aged ≥85 years did not have any survival difference by treatment intent (median survival for patients aged 85–89 years: LGICa‐Cur 31 months vs. LGICa‐Pal 16 months; p = 0.062; median survival for patients aged ≥90 years: LGICa‐Cur 14 months vs. LGICa‐Pal 16 months; p = 0.703).ConclusionPatients with LGICa aged ≥85 years have similar survival whether treated with curative or palliative intent. This can inform management discussions with patients and LGI‐2WW referral pathway prioritization approaches.

ASO Author Reflections: Quality of Life and Survival Outcomes in Elderly Patients Undergoing Pelvic Exenteration.

ASO Author Reflections: Quality of Life and Survival Outcomes in Elderly Patients Undergoing Pelvic Exenteration.

Predicting Survival Benefit of Sparing Sentinel Lymph Node Biopsy in Low-Risk Elderly Patients With Early Breast Cancer: A Population-Based Analysis.

Objective: The application of sentinel lymph node biopsy (SLNB) in elderly patients with early breast cancer remains somewhat controversial. This study aimed to establish individualized nomograms to predict survival outcomes of elderly patients with and without SLNB and find out which patients could avoid SLNB.Methods: A total of 39,962 ≥70-year-old patients diagnosed with T1–T2 breast cancer in 2010–2015 were included from the Surveillance, Epidemiology, and End Results (SEER) program and were divided into the training set (n = 29,971) and the validation set (n = 9,991). Axillary surgery was not specified in the SEER database, and we defined removing one to five lymph nodes as SLNB. Survival analysis was performed using the Kaplan–Meier plot and log-rank test. Multivariate Cox analysis was utilized to identify risk factors for overall survival (OS) and breast-cancer-specific survival (BCSS). Nomograms and a risk stratification model were constructed.Results: In the training set, patients with SLNB had better OS (adjusted HR 0.57, P < 0.001) and BCSS (adjusted HR 0.55, P < 0.001) than patients without SLNB. Multivariate COX analysis identified age, marital status, grade, subtype, T stage, and radiation as independent risk factors for OS and BCSS in both SLNB and non-SLNB groups (all P < 0.05). They were subsequently incorporated to establish nomograms to predict 3- and 5-year OS and BCSS for patients with or without SLNB. The concordance index ranged from 0.687 to 0.820, and calibration curves in the internal set and external set all demonstrated sufficient accuracies and good predictive capabilities. Further, we generated a risk stratification model which indicated that SLNB improved OS and BCSS in high-risk group (OS: HR 0.49, P < 0.001; BCSS: HR 0.54, P < 0.001), but not in the low-risk group (all P > 0.05).Conclusion: Well-validated nomograms and a risk stratification model were constructed to evaluate survival benefit from SLNB in elderly patients with early-stage breast cancer. SLNB was important for patients in the high-risk group but could be omitted in the low-risk group without sacrificing survival. This study could assist clinicians and elderly patients to weigh the risk–benefit of SLNB and make individualized decisions. We look forward to more powerful evidence from prospective trials.

Functional and survival outcomes in elderly patients undergoing transoral robotic surgery.

To determine if elderly patients (≥70years) have differences in functional and survival outcomes compared to non-elderly patients (<70years) following transoral robotic surgery. A retrospective cohort study was conducted on patients undergoing robotic surgery for head and neck cancer at a tertiary institution from 2011 to 2016. Functional status was evaluated with diet, enteric feeding status, Functional Oral Intake Scale (FOIS), tracheostomy tube placement, and unplanned readmission. Kaplan Meier method and Cox proportional hazard model were used to assess overall survival (OS) and disease-free survival (DFS) between elderly and non-elderly patients. Two hundred and forty-six patients met inclusion criteria. The mean age of the cohort was 63.5±9.74years. There were 64 patients (26.0%) that were ≥70years. Elderly patients were more likely to be discharged with enteric access (p<0.002). As early as 3months, there was no significant difference in need for enteric feeds, diet, or FOIS score. There was no difference in tracheostomy tube rates and unplanned readmission between both cohorts. There was no significant difference in OS and DFS between age groups when stratified by p16 status. Elderly patients are more likely to require perioperative enteric feeding, but 3-month, 1-year, and 2-year functional outcomes are comparable to younger patients. Survival outcomes are similar in both populations.

Survival outcomes of elderly patients with pathological stages II and III gastric cancer following curative gastrectomy.

AimSurvival outcomes in elderly patients with pathological stages (pStages) II and III gastric cancer remain inadequately elucidated. We retrospectively analyzed outcomes of elderly and nonelderly patients who underwent curative gastrectomy for this cancer and considered clinical results of the Estimation of Physiologic Ability and Surgical Stress (E‐PASS) scoring system for prediction.MethodsAmong 1041 patients who underwent gastrectomy for pStages II and III gastric cancer between 2008 and 2013 consecutively, 898 patients were enrolled. Of these, 158 patients (17.6%) were elderly and 740 patients (82.4%) were nonelderly.ResultsDisease‐specific survival (DSS) in the elderly group with pStage III cancer was significantly worse than that in the same stage nonelderly group (P = .001), while there was no difference in DSS for pStage II cancer between the groups (P = .45). Overall survival (OS) was significantly worse in elderly patients for both pStages II and III. Elderly patients with pStage II cancer had larger survival gaps between OS and DSS compared with those with pStage III cancer. OS for elderly patients with comprehensive risk score (CRS) > 0.159 was significantly worse than that for elderly patients with CRS ≤ 0.159 in pStage II cancer.ConclusionsCompared with nonelderly patients, different characteristics were observed in the survival outcomes of elderly patients between pStages II and III gastric cancer. The survival gap between OS and DSS of elderly patients was larger in pStage II cancer than in pStage III cancer. The E‐PASS scoring system could be a relatively useful predictor in elderly patients.