Purpose

Adjuvant chemotherapy is recommended following colorectal cancer resection based on risk of recurrence. In older patients, treatment decisions should consider recurrence rates and tolerability, as well as functional prognosis, residual disease, and social factors. This study aims to investigate factors, including social background, influencing implementation of postoperative adjuvant chemotherapy in older patients undergoing curative resection for colorectal cancer.

Methods

This multi-institutional prospective cohort study included 15 institutions belonging to the Hiroshima Surgical study group for Clinical Oncology. We analyzed 159 older patients aged ≥ 80 years, who underwent curative resection for stage III colorectal cancer between December 2013 and June 2018, as sub-analysis of the HiSCO-04 study.

Results

In total, 62 (39.0%) patients underwent postoperative adjuvant chemotherapy. Four factors were significantly associated with its implementation: performance status < 2, Charlson Comorbidity Index < 2, prognostic nutritional index ≥ 40, and presence of a spouse or siblings as lifestyle supporters. No significant difference was found in the backgrounds between complete and incomplete postoperative adjuvant chemotherapy patients.

Conclusion

Performance status, Charlson Comorbidity Index, nutritional status, and presence of a spouse or siblings as lifestyle supporters are possible factors influencing the implementation of postoperative adjuvant chemotherapy in older patients. To select appropriate treatment options, including postoperative adjuvant chemotherapy, it is essential to consider physical condition and comorbidities of older patients, thoroughly explain the situation to their families, and establish a support system to enhance understanding of the available treatment options.

中文翻译：

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接受结直肠癌根治性切除的老年患者的社会背景与术后辅助化疗实施之间的关联，HiSCO-04 研究的亚分析

目的

根据复发风险，建议结直肠癌切除后进行辅助化疗。对于老年患者，治疗决策应考虑复发率和耐受性，以及功能预后、残留疾病和社会因素。本研究旨在探讨影响接受结直肠癌根治性切除的老年患者术后辅助化疗实施的因素，包括社会背景。

方法

这项多机构前瞻性队列研究包括属于广岛外科临床肿瘤学研究组的 15 家机构。作为 HiSCO-04 研究的子分析，我们分析了 159 名年龄≥ 80 岁的老年患者，这些患者在 2013 年 12 月至 2018 年 6 月期间接受了 III 期结直肠癌根治性切除术。

结果

总共有 62 名（39.0%）患者接受了术后辅助化疗。有四个因素与其实施显着相关：体能状态 < 2、查尔森合并症指数 < 2、预后营养指数 ≥ 40 以及配偶或兄弟姐妹作为生活方式支持者。完全和不完全术后辅助化疗患者的背景没有发现显着差异。

结论

体力状况、查尔森合并症指数、营养状况以及配偶或兄弟姐妹作为生活方式支持者的存在是影响老年患者术后辅助化疗实施的可能因素。为了选择合适的治疗方案，包括术后辅助化疗，必须考虑老年患者的身体状况和合并症，向家人充分解释情况，并建立支持系统以加深对可用治疗方案的了解。