Adjuvant Chemotherapy in Elderly Patients with Colon Cancer: A Retrospective Study
Bibliographic record
Abstract
Purpose: Although benefits have been clearly demonstrated for stage III colon cancer, the effects of adjuvant chemotherapy on the elderly population have been questioned. This study was undertaken to review our local experience with diagnosis, staging, and treatment of colon cancer in this population. Methods: All patients aged ≥75 years operated for colon cancer at the Centre Hospitalier Universitaire de Sherbrooke between 2005 and 2012 were identified. Information related to diagnostic modalities, type of surgeries, perioperative complications, pathology results, chemotherapy treatment, and overall outcomes were retrospectively analyzed. Overall survival (OS) and disease-free survival (DFS) were estimated with Kaplan-Mayer plots. Results: A total of 205 patients were included (mean age 81.3±4.5 years; 43.9% of males). The major comorbidities were hypertension (71.2%), coronary artery disease (32.2%), peripheral artery disease (21.5%), diabetes (21.0%), prior neoplasia (16.1%), chronic bronchitis (14.1%), and chronic renal failure (13.7%). For staging purpose, colonoscopy was performed in 88.8% of patients, preoperative CEA in 85.4%, abdominal CT in 87.3%, chest CT in 46.3%, and PET CT in 11.2%. There were 54.1% of perioperative complications, the most frequent being infections (40.5%), cardiovascular events (21.6%), ileus/obstruction (9.9%), bleeding (7.2%), delirium (5.4%), and thromboembolic events (5.4%).The perioperative 30-day mortality was 5.4%, and infections were responsible for 88.8% of these deaths. According to the AJCC classification V.7, tumors were identified as stage 0, I, II, and III in 1%,17.6%, 42.4%, and 39% of cases, respectively. In stage II patients, 26.1% were evaluated in oncology, and 4.5% had chemotherapy that consisted of capecitabine in 50% and 5-FU/LV in 50%. Whereas for stage III patients, 58.8% were evaluated in oncology, and 28.8% of them received adjuvant treatment. For stage III patients, chemotherapy regimens were capecitabine in 82.6%, FOLFOX in 8.7%, infusional 5-FU/LV in 4.3%, and bolus 5-FU in 4.3%. It was the surgeon's, the patient's, or the oncologist's decision to decline treatment in 33.3%, 29.8%, and 26.3%, respectively, for stage III patients. Overall, neither DFS at 5 years was significantly improved (59.2% vs. 56.9%; p=0.98) nor was OS at 5 years (58.3% vs. 60.3%; p=0.98) in patients treated with vs. without adjuvant chemotherapy. Results were similar in the stage III population, with 5-year DFS of 60.2% vs. 38% (p=0.22) and 5-year OS of 59.8% vs. 41.9% (p=0.24). Conclusion: Our local experience did not show any improvement on disease-free survival and on overall survival for elderly patients treated with adjuvant chemotherapy for colon cancer.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".