Peritoneal metastases in elderly patients with colorectal cancer
European Journal of Surgical Oncology(2022)
Abstract
Background
With the introduction of cytoreductive surgery with intraperitoneal chemotherapy and the development of new systemic anti-cancer agents, the treatment of colorectal cancer (CRC) patients with peritoneal metastases has changed. Real-world data on the treatment of elderly patients and their clinical outcomes is lacking.
Methods
All CRC patients diagnosed with synchronous peritoneal metastases (SPM) during 2008–2019 (n = 7,748) were identified from the Netherlands Cancer Registry. Trends in treatment and postoperative mortality were described by age category (<70, 70–74, 75–79, ≥80 years) and period of diagnosis (2008–2013, 2014–2019). Kaplan-Meier curves were constructed, and log-rank tests were performed to evaluate differences in overall survival (OS).
Results
With increasing age, less patients received multimodality treatment and systemic treatment. Of the patients aged <70 years, 38% underwent multimodality treatment and 35% palliative systemic therapy, declining to 4% and 12% in patients ≥80 years. A large and increasing proportion of elderly patients did not receive cancer-directed treatment, this increased from 32% in 2008–2013 to 41% in 2014–2019 in 75–79 years old patients and from 52% to 65% in ≥80 years old. Postoperative mortality decreased in all age categories over time, OS remained stable. The median OS of elderly patients ranged from 8 months in 70–74 years old to 3 months in patients aged ≥80 years.
Discussion
Age strongly affects treatment of patients with SPM, with a large and increasing proportion of elderly patients not receiving cancer-directed treatment. Their prognosis remains very poor. There is a need for therapeutic options that are well tolerable for elderly patients.
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Key words
Peritoneal metastases,Colorectal cancer,Elderly,Treatment,Survival,Trends
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