Octogenarian patients with colorectal cancer: Characterizing an emerging clinical entity

Table 1 Patient characteristics¹n (%)

	Study cohort	Older (age ≥ 80 yr)	Younger (age < 80 yr)	P value
	(n = 350)	(n = 175)	(n = 175)
Median age (range)	80 (20-99)	83 (80-99)	63 (20-79)	-
Male gender	155 (44.3)	84 (48)	71 (40.6)	0.162
Ethnicity
Ashkenazi	193 (56.4)	112 (64.8)	81 (47.9)	< 0.001
Sephardic	120 (35.1)	58 (33.5)	62 (36.7)
Arab	12 (3.5)	0 (0)	12 (7.1)
Other	17 (5)	3 (1.7)	14 (8.3)
2nd malignancy	63 (18.1)	39 (22.4)	24 (13.7)	0.035
Family history of cancer	157 (51.1)	53 (36.3)	104 (64.6)	< 0.001
Family history of CRC	65 (21.2)	21 (14.4)	44 (27.3)	0.006
IBD	1 (0.3)	1 (0.6)	0 (0)	0.335
Polyps2	122 (35.4)	55 (33.2)	67 (38.5)	0.233
HNPCC/FAP	9 (2.7)	5 (3)	4 (2.4)	0.695
Smoking history	104 (34.9)	41 (24.6)	74 (44.3)	< 0.001
Diagnosis d/t screening	45 (12.9)	10 (5.7)	35 (20)	< 0.001
Performance status3 of 0-1	268 (82.5)	115 (71)	153 (93.9)	< 0.001

¹Valid percentages. Missing data as follows: ethnicity (n = 8); 2^nd malignancy (n = 1); family history of malignancy (n = 43); family history of CRC (n = 43); IBD (n = 5), polyps (n = 5); HNPCC/FAP (n = 14); smoking history (n = 16), performance status (n = 25);

²Polyps- diagnosis of polyps before or during CRC diagnosis;

³Performance status was determined according to the Eastern Cooperative Oncology Group score during the first encounter with the oncologist. CRC: Colorectal cancer; IBD: Inflammatory bowel disease; FAP: Familial adenomatous polyposis; HNPCC: Hereditary non-polyposis colorectal cancer; d/t: Due to.

Table 2 Tumor characteristics¹n (%)

	Study cohort	Older (age ≥ 80 yr)	Younger (age < 80 yr)	P value
	(n = 350)	(n = 175)	(n = 175)
Tumor location2
Right colon	140 (40)	80 (45.7)	60 (34.3)	0.029
Left colon/rectum	210 (60)	95 (54.3)	115 (65.7)
Histology				0.201
NOS	260 (76.5)	124 (74.2)	136 (78.6)
Mucinous	64 (18.8)	38 (22.8)	26 (15)
Signet ring cell	11 (3.2)	3 (1.8)	8 (4.6)
Other	5 (1.5)	2 (1.2)	3 (1.78)
Grade3				0.025
1	48 (14.8)	17 (10.4)	31 (19.3)
2-3	276 (85.2)	146 (89.3)	130 (80.7)
T				0.27
T1	17 (5.2)	5 (3.1)	12 (7.4)
T2	57 (17.6)	28 (17.4)	29 (17.8)
T3	237 (73.2)	123 (76.4)	114 (69.9)
T4	13 (4)	5 (3.1)	8 (4.9)
N				0.357
N0	179 (67)	94 (71.2)	85 (63)
N1	56 (21)	24 (18.2)	32 (23.7)
N2	32 (12)	14 (10.6)	18 (13.3)
M1	72 (20.7)	34 (19.8)	38 (21.7)	0.655
TNM stage				0.259
I	65 (19)	30 (17.7)	35 (20.2)
II	116 (33.8)	66 (38.8)	50 (28.9)
III	90 (26.2)	40 (23.5)	50 (28.9 )
IV	72 (21)	34 (20)	38 (22)
LVI	18 (6)	11 (7.5)	7 (4.6)	0.296
VVI	36 (11.9)	15 (10.1)	21 (13.6)	0.348
Obstruction4	36 (10.3)	22 (12.6)	14 (8)	0.159
Perforation4	12 (3.4)	10 (5.7)	2 (1.1)	0.019
Synchronous CRC	11 (3.1)	4 (2.3)	7 (4)	0.358
Metachronous CRC	2 (0.6)	1 (0.6)	1 (0.6)	0.997
RAS mutated	8 (22.2)	2 (15.4)	6 (26.1)	0.458
BRAF mutated	1 (3.7)	0 (0)	1 (7.7)	0.29
MSI-H	6 (25)	3 (100)	3 (14.3)	0.001

¹Valid percentages. Missing data as follows: histology (n = 10); grade (n = 26); T stage (n = 26); N status (n = 83); M status (n = 3); TNM stage (n = 7); lymphatic invasion (n = 51); vascular invasion (n = 48); metachronous tumor (n = 1); KRAS (n = 314); BRAF (n = 323); MSI-H (n = 326);

²Right colon = appendix, ascending colon and transverse colon, Left colon = descending colon and sigma;

³Grade 1 = well differentiated, grade 2 moderately differentiated, poorly differentiated;

⁴Obstruction or perforation at presentation. CRC: Colorectal cancer; NOS: Not otherwise specified; LVI: Lymphovascular invasion; VVI: Venovascular invasion; MSI-H: Microsatellite instability- high.

Table 3 Treatment¹

	Study cohort	Older (age ≥ 80 yr)	Younger (age < 80 yr)	P value
No. of LN dissected, mean (SD)2	14.4 (6.1)	14.3 (5.4)	14.4 (6.8)	0.893
Adjuvant/neoadjuvant Tx2	119/271 (43.9)	38/138 (27.5)	81/133 (60.9)	< 0.0001
Oxaliplatin-based adjuvant chemotherapy2	58/116 (50)	11/37 (29.7)	47 (59.5)	0.002
No. of chemotherapy lines in stage IV3
0	12 (20)	9 (34.6)	3 (8.8)	0.016
1	24 (40)	11 (42.3)	13 (38.2)
≥ 2	24 (40)	6 (23.1)	18 (53)
Type of chemotherapy in stage IV, 1st line34				0.239
Fluoropyrimidine	11 (21.6)	6 (30)	5 (16.1)
Fluoropyrimidine+oxaliplatin/irinotecan	40 (78.4)	14 (70)	26 (80.9)
Local interventions to metastatic sites5				< 0.001
None	45 (57)	28 (90.3)	17 (35.4)
Surgery ± other local intervention	31 (39.2)	2 (6.5)	29 (60.4)
Other local intervention	3 (3.8)	1 (3.2)	2 (4.2)
Hematological toxicity, grade ≥ 3	17 (11)	4 (8)	13 (12.5)	0.404
Non-hematological toxicity, grade ≥ 3	37 (23.6)	9 (18)	28 (26.7)	0.261

¹Valid percentages. Missing data as follows: adjuvant/neoadjuvant treatment (n = 4); no. of lymph nodes dissected (n = 20); type of chemotherapy (n = 7); No. of chemotherapy lines (n = 12); local intervention to a metastatic site (n = 4), hematological toxicity (n = 19); non-hematological toxicity (n = 19);

²Data regarding patients who presented with non-metastatic disease;

³Data regarding patients who presented with metastatic disease;

⁴Chemotherapy was given with or without a biological agent including bevacizumab, cetuximab or panitumumab;

⁵Local intervention to a metastatic site included: radiofrequency ablation, chemoembolization, intra-arterial chemotherapy, stereotactic body irradiation, and radiotherapy. LN: Lymph nodes; Tx: Treatment.

Table 4 Univariate and multivariate analyses of cancer specific survival and disease free survival

	Univariate analysis CSS1		Multivariate analysis CSS12		Univariate analysis DFS3		Multivariate analysis DFS23
	5-yr CSS	P value	Hazard ratio	P value	5-yr DFS	P value	Hazard ratio	P value
Age (yr)	63%	0.009	1.7 (0.8-3.6)	0.155	71%	0.226	1.2 (0.5-2.9)	0.668
≥ 80	78%				79%
< 80
Gender		0.274	0.9 (0.5-1.6)	0.762		0.682	1.1 (0.5-2.2)	0.865
Male	68%				77%
Female	73%				74%
Ethnicity		0.293	-	-		0.608	-	-
Ashkenazi	73%				73%
Sephardic	65%				78%
Arab	88%				69%
Other	79%				93%
Second malignancies		0.497	-	-		0.429	-	-
Yes	75%				81%
No	70%				74%
Family hx of cancer		0.068	-	-		0.096	-	-
Yes	78%				82%
No	68%				71%
Family hx of CRC		0.024	0.3 (0.1-0.8)	0.015		0.048	0. 2 (0.1-0.8)	0.016
Yes	86%				91%
No	70%				73%
Performance status		0.0003	1.2 (0.5-3)	0.62		0.068	2.1 (0.7-6.3)	0.175
0-1	77%				78%
2-4	53%				60%
Mode of Diagnosis		0.024	1 (0.3-3.4)	0.973		0.235	-	-
Symptoms	68%				74%
Screening	90%				85%
Tumor location		0.102	-	-		0.723	-	-
Right colon	66%				77%
Left colon/rectum	75%				75%
Histology		< 0.0001	5.7 (1.5-21.1)	0.009		< 0.0001	6.9 (1.7-28)	0.007
NOS/mucinous/other	74%				77%
Signet ring cell	33%				48%
Grade		0.05	-	-		0.561	-	-
1	87%				71%
2-3	69%				76%
T			-	-			-	-
T1	92%	< 0.0001			100%	< 0.0001
T2	90%				82%
T3	73%				72%
T4	39%				76%
N		0.0003	-	-		0.001	-	-
N0	89%				81%
N1	79%				72%
N2	56%				57%
M		< 0.0001	-	-	-	-	-	-
M0	85%
M1	26%
TNM stage		< 0.0001		-		0.014
I	94%		1	0.433	90%		1	-
II	90%		1.9 (0.4-8.7)	0.013	77%		3.5 (0.8-15.6)	0.107
III	73%		6.7 (1.5-30.1)	< 0.0001	63%		8.4 (1.9-36.4)	0.004
IV	26%		20 (4.6-87.6)		-		-	-
LVI		0.073	-	-		0.848	-	-
Yes	57%				79%
No	75%				75%
VVI		0.272	-	-		0.791	-	-
Yes	65%				72%
No	75%				76%
Obstruction		0.001	2.3 (0.99-5.4)	0.052		0.001	2.95 (1.1-7.9)	0.03
Yes	49%				49%
No	74%				79%
Perforation		0.0001	3.5 (1.1-10.9)	0.028		0.262	-	-
Yes	28%				64%
No	73%				76%
Adjuvant/neoadjuvant tx			-	-			-	-
Yes	87%	0.137			72%	0.236
No	78%				80%
Local Tx to metastatic sites			-	-	-	-	-	-
Yes	41%	0.007
No	20%

¹Univariate and multivariate analysis for CSS were performed for patients with stage I-IV;

²Multivariate analysis was calculated for the entire follow-up period. The column of multivariate analysis depicts only factors that were included in the model;

³Univariate and multivariate analysis for DFS were performed for patients with stage I-III. DFS: Disease free survival; CRC: Colorectal cancer; CSS: Cancer specific survival; LVI: Lymphovascular invasion; NA: Not applicable; NOS: Not otherwise specified; Tx: Treatment; VVI: Venovascular invasion.