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Prediction of overall survival following colorectal cancer surgery in elderly patients

World Journal of Gastrointestinal Surgery 2019年第5期11卷 247-260页

作者： Isaac Seow-En Winson Jianhong Tan sreemanee raaj dorajoo Sharon Hui Ling Soh Yi Chye Law Soo Yeun Park Gyu-Seok Choi Wah Siew Tan Choong Leong Tang Min Hoe Chew Department of Colorectal Surgery Singapore General HospitalSingapore 169608Singapore Department of General Surgery Sengkang General HospitalSingapore 544886Singapore Department of Pharmacy National University of SingaporeSingapore 117559Singapore Yong Loo Lin School of Medicine National University of SingaporeSingapore 117597Singapore Colorectal Cancer Center Kyungpook National University Chilgok HospitalKyungpook National University School of MedicineDaegu 702-210South Korea

BACKGROUND With advanced age and chronic illness,the life expectancy of a patient with colorectal cancer(CRC)becomes less dependent on the malignant disease and more on their pre-morbid condition.Justifying major surgery for these elderly patients can be challenging.An accurate tool demonstrating post-operative survival probability would be useful for surgeons and their patients.AIM To integrate clinically significant prognostic factors relevant to elective colorectal surgery in the elderly into a validated pre-operative scoring system.METHODS In this retrospective cohort study,patients aged 70 and above who underwent surgery for CRC at Singapore General Hospital between 1 January 2005 and 31 December 2012 were identified from a prospectively maintained database.Patients with evidence of metastatic disease,and those who underwent emergency surgery or had surgery for benign colorectal conditions were excluded from the analysis.The primary outcome was overall 3-year overall survival(OS)following surgery.A multivariate model predicting survival was derived and validated against an equivalent external surgical cohort from Kyungpook National University Chilgok Hospital,South Korea.Statistical analyses were performed using Stata/MP Version 15.1.RESULTS A total of 1267 patients were identified for analysis.The median post-operative length of stay was 8[interquartile range(IQR)6-12]d and median follow-up duration was 47(IQR 19-75)mo.Median OS was 78(IQR 65-85)mo.Following multivariate analysis,the factors significant for predicting overall mortality were serum albumin<35 g/dL,serum carcinoembryonic antigen≥20μg/L,T stage 3 or 4,moderate tumor cell differentiation or worse,mucinous histology,rectal tumors,and pre-existing chronic obstructive lung disease.Advanced age alone was not found to be significant.The Korean cohort consisted of 910 patients.The Singapore cohort exhibited a poorer OS,likely due to a higher proportion of advanced cancers.Despite the clinicopathologic differences,there was successful validation of the

关键词： Colorectal cancer surgery Elderly Overall survival Pre-operative prognostic score

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