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. 2022 Apr;11(8):1735-1744.
doi: 10.1002/cam4.4540. Epub 2022 Feb 11.

Causes of mortality in elderly UICC stage III colon cancer (CC) patients--Tumor-related death and competing risks from the German AIO colorectal study group Colopredict Plus (CPP) registry

Stefanie Nöpel-Dünnebacke  1 , Hendrick Jütte  2 , Robin Denz  3 , Inke Sabine Feder  2 , Anna-Lena Kraeft  1 , Celine Lugnier  1 , Christian Teschendorf  4 , Daniela Collette  5 , Hinrich Böhner  6 , Lars Engel  7 , Lothar Mueller  8 , Frank Hartmann  9 , Ulrich Kaiser  10 , Harald-Robert Bruch  11 , Stephan Hollerbach  12 , Dirk Arnold  13 , Nina Timmesfeld  3 , Andrea Tannapfel  2 , Anke Reinacher-Schick  1
Affiliations

Causes of mortality in elderly UICC stage III colon cancer (CC) patients--Tumor-related death and competing risks from the German AIO colorectal study group Colopredict Plus (CPP) registry

Stefanie Nöpel-Dünnebacke et al. Cancer Med. 2022 Apr.

Abstract

Background: Colon cancer (CC) is a disease of elderly patients (pts.) with a median age of 73 years (yrs.). Lack of data about the effects of adjuvant chemotherapy (ACT) is caused by underrepresentation of this clinically relevant cohort in interventional trials. We analyzed real-world data from the German CPP registry with regard to a possible benefit of ACT in elderly (70+ yrs.) versus younger pts. (50 to <70 yrs.) taking cause-specific deaths into account.

Methods: We analyzed the effect of age and ACT on overall survival (OS) and cause-specific death of stage III pts. using Cox regression.

Results: In total, 1558 pts. were analyzed and follow-up was 24.6 months. 62.6% of the elderly received ACT whereas 91.1% of younger pts. (p < 0.001). Oxaliplatin combinations were significantly less often given to older than younger pts. (38.8% vs. 88.9%; p < 0.001). Mean Charlson comorbidity score was significantly lower in pts. that received ACT (0.61) than in those without ACT (1.16; p < 0.001). ACT was an independent positive prognostic factor for cancer-related death in elderly pts. even in pts. 75+ yrs. No significant difference in the effect of ACT could be observed between age groups (interaction: cancer-specific death HR = 1.7948, p = 0.1079; death of other cause HR = 0.7384, p = 0.6705).

Conclusion: ACT was an independent positive prognostic factor for OS. There may be a cohort of elderly with less co-morbidities who benefit from ACT.

Keywords: adjuvant treatment; early colon cancer; elderly; tumor-related death.

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Conflict of interest statement

Stefanie Nöpel Dünnebacke: Honoraria/Advisory Boards: BMS, Merck, and Roche. Anke Reinacher‐Schick: Honoraria: Amgen, AstraZeneca, BMS, Celgene, Lilly, Merck Serono, MSD, Pfizer, Roche, Sanofi‐Aventis, Servier, Advisory Boards: Amgen, AstraZeneca, BMS, Celgene, Lilly, Merck Serono, MSD, Pfizer, Roche, Sanofi‐Aventis, Servier, Baxalta, Pierre‐Fabre, Trial support: Amgen, AstraZeneca, Celgene, Ipsen, Lilly, Roche, Servier, and Mologen Berlin. Andrea Tannapfel: Honoraria/Advisory Board/ Trial Support: Roche, Amgen, Falk, and Celgene.

Figures

FIGURE 1
FIGURE 1
Consort diagram of the subgroup analysis of CPP
FIGURE 2
FIGURE 2
Barplot of the frequency of molecular alterations such as RAS/BARF MT and MSI‐H versus MSS. MSI‐H, high microsatellite instability; MSS, microsatellite stability; MT, mutation; WT, wildtype
FIGURE 3
FIGURE 3
(A and B) median disease free survival (DFS, A) and overall survival (OS, B) in UICC stage III patients (pts.) in age groups (50 to <70 vs. 70+ yrs.) and with vs. without adjuvant chemotherapy (ACT) adjusted to the Charlson Comorbidity Score (CCS); red: pts. 50 to <70 yrs. with ACT; blue: pts. 70+ yrs. with ACT; green: pts. 50 to <70 yrs. without ACT; violet: pts. 70+ yrs. without ACT. (C and D) disease free survival (DFS, C) and overall survival (OS, D) in UICC stage III patients (pts.) 75+ yrs. with vs. without adjuvant chemotherapy (ACT) adjusted to the Charlson Comorbidity Score (CCS); blue: with ACT, red: without ACT
FIGURE 4
FIGURE 4
Forest plots for cancer specific death (A) and death from other causes (B); Hazard ratio (95% Confidence interval)
FIGURE 5
FIGURE 5
Causes of death od UICC stage III pts. in two age groups (50 to <70 yrs. (A, B). vs. 70+ yrs. (C, D)) and adjuvant chemotherapy (ACT; B, D) and no treatment (A, C). Grey: alive pts., violet: unknown death, blue: other cause, red: cancer
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