A substantial proportion of patients with stage III colorectal cancer (CRC) are older than 70 years. Optimal adjuvant chemotherapy (AC) for older patients (OP) continues to be debated, with subgroup analyses of randomized trials not demonstrating a survival benefit from the addition of oxaliplatin to a fluoropyrimidine backbone. We analyzed the multisite Australian ACCORD registry, which prospectively collects patient, tumor and treatment data along with long term clinical follow-up. We compared OP (≥70) with stage III CRC to younger patients ([YP] <70), including the proportion recommended AC and any reasons for not prescribing AC. AC administration, regimen choice, completion rates, and survival outcomes were also examined. One thousand five hundred twelve patients enrolled in the ACCORD registry from 2005 to 2018 were included. Median follow-up was 57.0 months. Compared to the 827 YP, the 685 OP were less likely to be offered AC (71.5% vs. 96.5%, < .0001) and when offered, were more likely to decline treatment (15.1% vs. 2.8%, < .0001). Ultimately, 60.0% of OP and 93.7% of YP received AC ( < .0001). OP were less likely to receive oxaliplatin (27.5% vs. 84.7%, < .0001) and to complete AC (75.9% vs. 85.7%, < .0001). The probability of remaining recurrence-free was significantly higher in OP who received AC compared to those not treated (HR 0.73, = .04) but not significantly improved with the addition of oxaliplatin (HR 0.75, = .18). OP were less likely than YP to receive AC. Receipt of AC reduced recurrences in OP, supporting its use, although no significant benefit was observed from the addition of oxaliplatin.

中文翻译：

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老年 III 期结直肠癌患者的辅助化疗：治疗建议、治疗实施和对癌症复发影响的真实世界分析

很大一部分 III 期结直肠癌 (CRC) 患者年龄超过 70 岁。老年患者 (OP) 的最佳辅助化疗 (AC) 仍在争论中，随机试验的亚组分析并未证明在氟嘧啶骨架中添加奥沙利铂可带来生存获益。我们分析了澳大利亚多站点 ACCORD 注册中心，该注册中心前瞻性地收集患者、肿瘤和治疗数据以及长期临床随访数据。我们将 OP (≥70) 与 III 期 CRC 与年轻患者 ([YP] <70) 进行比较，包括推荐 AC 的比例以及不开 AC 的任何原因。还检查了 AC 给药、方案选择、完成率和生存结果。2005 年至 2018 年期间，共有 1512 名患者登记在 ACCORD 登记处。中位随访时间为 57.0 个月。与 827 YP 相比，685 OP 接受 AC 治疗的可能性较小（71.5% vs. 96.5%，< .0001），并且在接受治疗时更有可能拒绝治疗（15.1% vs. 2.8%，< .0001） 。最终，60.0% 的 OP 和 93.7% 的 YP 获得了 AC (< .0001)。OP 不太可能接受奥沙利铂（27.5% vs. 84.7%，< .0001）和完成 AC（75.9% vs. 85.7%，< .0001）。与未接受治疗的 OP 相比，接受 AC 治疗的 OP 保持无复发的概率显着较高 (HR 0.73, = .04)，但添加奥沙利铂后未显着改善 (HR 0.75, = .18)。OP 获得 AC 的可能性低于 YP。接受 AC 减少了 OP 的复发，支持其使用，尽管添加奥沙利铂没有观察到显着的益处。