Copyright
©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Octogenarian patients with colorectal cancer: Characterizing an emerging clinical entity
Hadar Goldvaser, Noa Katz Shroitman, Irit Ben-Aharon, Ofer Purim, Yulia Kundel, Daniel Shepshelovich, Tzippy Shochat, Aaron Sulkes, Baruch Brenner
Hadar Goldvaser, Irit Ben-Aharon, Ofer Purim, Yulia Kundel, Aaron Sulkes, Baruch Brenner, Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tikva 4941492, Israel
Hadar Goldvaser, Noa Katz Shroitman, Irit Ben-Aharon, Ofer Purim, Yulia Kundel, Daniel Shepshelovich, Aaron Sulkes, Baruch Brenner, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv 64239, Israel
Hadar Goldvaser, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre and the Department of Medicine, University of Toronto, Toronto M5G 0A4, Canada
Daniel Shepshelovich, Department of Medicine A, Beilinson Hospital, Rabin Medical Center, Petach Tikva 4941492, Israel
Tzippy Shochat, Statistical Consulting Unit, Beilinson Hospital, Rabin Medical Center, Petach Tikva 4941492, Israel
Author contributions: Goldvaser H and Brenner B contributed to study conception and design of the study; Goldvaser H, Katz Shroitman N, Ben-Aharon I, Purim O and Kundel Y contributed to data acquisition; Goldvaser H, Shepshelovich D, Shochat T, Sulkes A and Brenner B contribued to analysis and interpretation of data; Goldvaser H, Katz Shroitman N and Brenner B drafted the article; Ben-Aharon I, Purim O, Kundel Y, Shespshelovich D, Shochat T and Sulkes A made critical revisions related to important intellectual content of the manuscript; Goldvaser H, Katz Shroitman N, Ben-Aharon I, Purim O, Kundel Y, Shespshelovich D, Shochat T, Sulkes A and Brenner B approved the version of the article to be published.
Institutional review board statement: The study was reviewed and approved by our institutional review board (No. of approval RMC 0644-13).
Informed consent statement: As this was a retrospective study, informed consent was not required.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at hadar7g@gmail.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hadar Goldvaser, MD, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski Street, Petach Tikva 4941492, Israel. hadar7g@gmail.com
Telephone: +972-3-9378004 Fax: +972-3-9377902
Received: November 10, 2016
Peer-review started: November 10, 2016
First decision: December 19, 2016
Revised: December 26, 2016
Accepted: January 11, 2017
Article in press: January 11, 2017
Published online: February 28, 2017
AIM
To characterize colorectal cancer (CRC) in octogenarians as compared with younger patients.
METHODS
A single-center, retrospective cohort study which included patients diagnosed with CRC at the age of 80 years or older between 2008-2013. A control group included consecutive patients younger than 80 years diagnosed with CRC during the same period. Clinicopathological characteristics, treatment and outcome were compared between the groups. Fisher’s exact test was used for dichotomous variables and χ2 was used for variables with more than two categories. Overall survival was assessed by Kaplan-Meier survival analysis, with the log-rank test. Cancer specific survival (CSS) and disease-free survival were assessed by the Cox proportional hazards model, with the Fine and Gray correction for non-cancer death as a competing risk.
RESULTS
The study included 350 patients, 175 patients in each group. Median follow-up was 40.2 mo (range 1.8-97.5). Several significant differences were noted. Octogenarians had a higher proportion of Ashkenazi ethnicity (64.8% vs 47.9%, P < 0.001), a higher rate of personal history of other malignancies (22.4% vs 13.7%, P = 0.035) and lower rates of family history of any cancer (36.6% vs 64.6%, P < 0.001) and family history of CRC (14.4% vs 27.3%, P = 0.006). CRC diagnosis by screening was less frequent in octogenarians (5.7% vs 20%, P < 0.001) and presentation with performance status (PS) of 0-1 was less common in octogenarians (71% vs 93.9%, P < 0.001). Octogenarians were more likely to have tumors located in the right colon (45.7% vs 34.3%, P = 0.029) and had a lower prevalence of well differentiated histology (10.4% vs 19.3%, P = 0.025). They received less treatment and treatment was less aggressive, both in patients with metastatic and non-metastatic disease, regardless of PS. Their 5-year CSS was worse (63.4% vs 77.6%, P = 0.009), both for metastatic (21% vs 43%, P = 0.03) and for non-metastatic disease (76% vs 88%, P = 0.028).
CONCLUSION
Octogenarians presented with several distinct characteristics and had worse outcome. Further research is warranted to better define this growing population.
Core tip: Data regarding octogenarians with colorectal cancer (CRC) are scarce. We compared octogenarians with CRC to younger patients. Octogenarians had a predominance of Ashkenazi ethnicity, a higher rate of personal history of other malignancies and a lower rate of family history of any cancer or of CRC. Their performance status (PS) at presentation was worse and their tumors were more likely to be located in the right colon and to have a poorer differentiation. Octogenarians received less treatment and treatment was less aggressive, regardless of PS. This might contribute to the worse outcome which was found among the octogenarians.
