Abstract
Introduction: There will be 147,950 new cases of colon and rectal cancers (CRC) diagnosed in 2020. Guidelines no longer recommend screening colonoscopy in patients >75 y/o. We sought to evaluate the incidence of colorectal cancer and treatment of patients with metastatic disease who were 75 years or older.
Methods: Utilizing the National Cancer Database we identified patients diagnosed with colorectal cancer and stratified based upon age >75. We further stratified by treatment and location of treatment academic vs community center. Mann-Whitney U and Kruskal were used to compare continuous variables and Pearson’s Chi-square test was used to compare categorical variables. Unadjusted survival analyses were performed using the Kaplan-Meier method. Multivariate analysis (MVA) was performed to identify predictors of survival. All statistical tests were two-sided and p<0.05 was considered significant.
Results: We identified 167,059 patients with CRC and 53,104 (31.8%) patients were >75 y/o. There were 23,951 (45.1%) males and 29,153 (54.9%) females, p<0.001. Stage III represented 8321 (15.7%) of patients and metastatic disease was diagnosed in 10,614 (20%) and this was less frequent then their 50-75 counterparts (18.8% and 25.8% respectively), p<0.001. The lower incidence of metastatic disease persisted amongst all sites. Of the patients with metastatic disease, 2,617 (24.6%) underwent no treatment, 2322 (21.9%) underwent chemo or chemo XRT, 2472 (23.3%) underwent surgery + chemo and 3,202 (30.2%) underwent surgery only. The median and 5-year overall survival in patients opting for no treatment was (2.3 mo and 3%) compared to those treated with chemo only (10.2 mo and 4%) and surgery + chemo (20.7 mo and 13%), p<0.001. Patients treated at community centers had median and 5-year survival of 9.4 mo and 6% compared to those treated at academic centers (11.1 mo and 8%), p<0.001.
Conclusions: Patients >75 years have a high incidence of colon and rectal cancer despite changes in screening guidelines and a significant number of these patients will develop metastatic disease. Survival is benefited in these patients if they undergo surgery and if their treatment is at academic centers.
