Resectability, Resections, Survival Outcomes, and Quality of Life in Older Adult Patients with Metastatic Colorectal Cancer (the RAXO-Study)

被引：6

作者：

Lehtomaki, Kaisa ^{[1
,2
]}

Soveri, Leena-Maija ^{[3
,4
,5
]}

Osterlund, Emerik ^{[6
,7
]}

Lamminmaki, Annamarja ^{[8
,9
]}

Uutela, Aki ^{[6
,10
]}

Heerva, Eetu ^{[11
,12
]}

Halonen, Paivi ^{[3
,4
]}

Stedt, Hanna ^{[8
,9
]}

Aho, Sonja ^{[1
,2
]}

Muhonen, Timo ^{[13
]}

Algars, Annika ^{[11
,12
]}

Salminen, Tapio ^{[1
,2
]}

Kallio, Raija ^{[14
]}

Nordin, Arno ^{[6
,10
]}

Aroviita, Laura ^{[15
]}

Nyandoto, Paul ^{[16
]}

Kononen, Juha ^{[17
,18
]}

Glimelius, Bengt ^{[7
]}

Ristamaki, Raija ^{[11
,12
]}

Isoniemi, Helena ^{[6
,10
]}

Osterlund, Pia ^{[1
,2
,3
,4
,19
,20
]}

机构：

[1] Tampere Univ, Fac Med & Hlth Technol, Arvo Ylpon Katu 34, Tampere 33520, Finland

[2] Tampere Univ Hosp, Tays Canc Ctr, Dept Oncol, Teiskontie 35, Tampere 33520, Finland

[3] Helsinki Univ Hosp, Comprehens Canc Ctr, Dept Oncol, Helsinki 00290, Finland

[4] Univ Helsinki, Dept Oncol, Clin, Helsinki 00014, Finland

[5] Joint Municipal Author Hlth Care & Social Serv Ke, Home Care, Hyvinkaa 05850, Finland

[6] Helsinki Univ Hosp, Abdominal Ctr, Transplantat & Liver Surg, Helsinki 00290, Finland

[7] Uppsala Univ, Dept Immunol Genet & Pathol, S-75185 Uppsala, Sweden

[8] Kuopio Univ Hosp, Dept Oncol, Puijonlaaksontie 2, Kuopio 70210, Finland

[9] Univ Eastern Finland, Fac Hlth Sci, Yliopistonranta 1A, Kuopio 70210, Finland

[10] Univ Helsinki, Dept Surg, Clin, Helsinki 00014, Finland

[11] Turku Univ Hosp, Dept Oncol, Hameentie 11, Turku 20520, Finland

[12] Univ Turku, Dept Oncol, Kiinanmyllynkatu 10, Turku 20520, Finland

[13] South Carel Cent Hosp, Dept Oncol, Valto Kakelan Katu 1, Lappeenranta 53130, Finland

[14] Oulu Univ Hosp, Dept Oncol, Kajaanintie 50, Oulu 90220, Finland

[15] Kanta Hame Cent Hosp, Dept Oncol, Ahvenistontie 20, Hameenlinna 13530, Finland

[16] Paijat Hame Cent Hosp, Dept Oncol, Keskussairaalankatu 7, Lahti 15850, Finland

[17] Docrates Hosp, Docrates Canc Ctr, Saukonpaadenranta 2, Helsinki 00180, Finland

[18] Cent Finland Cent Hosp, Dept Oncol, Keskussairaalantie 19, Jyvaskyla 40620, Finland

[19] Karolinska Univ Sjukhuset, Dept Gastrointestinal Oncol, Tema Canc, Eugeniavagen 3, S-17176 Solna, Sweden

[20] Karolinska Inst, Dept Oncol Pathol, Solnavagen 1, S-17177 Solna, Sweden

来源：

JOURNAL OF CLINICAL MEDICINE | 2023年 / 12卷 / 10期

关键词：

older adults; metastatic colorectal cancer; metastasectomy; liver resection; lung resection; cytoreductive surgery; local ablative therapy; oncological treatment; health-related quality of life; COMPREHENSIVE GERIATRIC ASSESSMENT; LIVER METASTASES; ELDERLY-PATIENTS; YOUNGER PATIENTS; CLINICAL-TRIAL; INSTRUMENT; SURGERY;

D O I：

10.3390/jcm12103541

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Older adults are underrepresented in metastatic colorectal cancer (mCRC) studies and thus may not receive optimal treatment, especially not metastasectomies. The prospective Finnish real-life RAXO-study included 1086 any organ mCRC patients. We assessed repeated centralized resectability, overall survival (OS), and quality of life (QoL) using 15D and EORTC QLQ-C30/CR29. Older adults (>75 years; n = 181, 17%) had worse ECOG performance status than adults (<75 years, n = 905, 83%), and their metastases were less likely upfront resectable. The local hospitals underestimated resectability in 48% of older adults and in 34% of adults compared with the centralized multidisciplinary team (MDT) evaluation (p < 0.001). The older adults compared with adults were less likely to undergo curative-intent R0/1-resection (19% vs. 32%), but when resection was achieved, OS was not significantly different (HR 1.54 [CI 95% 0.9-2.6]; 5-year OS-rate 58% vs. 67%). 'Systemic therapy only' patients had no age-related survival differences. QoL was similar in older adults and adults during curative treatment phase (15D 0.882-0.959/0.872-0.907 [scale 0-1]; GHS 62-94/68-79 [scale 0-100], respectively). Complete curative-intent resection of mCRC leads to excellent survival and QoL even in older adults. Older adults with mCRC should be actively evaluated by a specialized MDT and offered surgical or local ablative treatment whenever possible.

引用

页数：21

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