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Association of age with outcomes in locally advanced rectal cancer treated with neoadjuvant therapy followed by surgery

  • Swati Sonal
    Affiliations
    Division of Gastrointestinal & Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA

    Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
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  • Author Footnotes
    1 Present address: Vanderbilt University Medical Center, Nashville, TN 37232, USA.
    Yasmeen Z. Qwaider
    Footnotes
    1 Present address: Vanderbilt University Medical Center, Nashville, TN 37232, USA.
    Affiliations
    Division of Gastrointestinal & Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA

    Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
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  • Author Footnotes
    2 Present address: University of Oxford, Oxford OX1 2JD, UK.
    Chloe Boudreau
    Footnotes
    2 Present address: University of Oxford, Oxford OX1 2JD, UK.
    Affiliations
    Division of Gastrointestinal & Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA

    Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
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  • Hiroko Kunitake
    Affiliations
    Division of Gastrointestinal & Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA

    Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
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  • Robert N. Goldstone
    Affiliations
    Division of Gastrointestinal & Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA

    Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
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  • Liliana G. Bordeianou
    Affiliations
    Division of Gastrointestinal & Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA

    Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
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  • Christy E. Cauley
    Affiliations
    Division of Gastrointestinal & Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA

    Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
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  • Todd D. Francone
    Affiliations
    Department of Colorectal Surgery, Newton-Wellesley Hospital, MA, 02462, USA
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  • Rocco Ricciardi
    Affiliations
    Division of Gastrointestinal & Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA

    Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
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  • David L. Berger
    Correspondence
    Corresponding author. Wang Ambulatory Care Center (WACC) 460, Division of Gastrointestinal & Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA
    Affiliations
    Division of Gastrointestinal & Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA

    Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
    Search for articles by this author
  • Author Footnotes
    1 Present address: Vanderbilt University Medical Center, Nashville, TN 37232, USA.
    2 Present address: University of Oxford, Oxford OX1 2JD, UK.
Published:December 13, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.12.002

      Highlights

      • Elderly patients with locally advanced rectal cancer (LARC) have worse OS & DFS.
      • Elderly patients with LARC have similar DSS as younger patients.
      • Comorbidity and adjuvant therapy, and not age, drive OS & DFS.

      Abstract

      Introduction

      We aimed to assess the association of age with outcomes in patients with Locally Advanced Rectal Cancer (LARC) who received neoadjuvant therapy followed by major surgery.

      Methods

      Retrospective review of 328 patients with LARC, N = 99 < 70 years (younger) versus N = 229 ≥ 70 years (elderly) from 2004 to 2018.

      Results

      Elderly patients had a higher American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), length of stay and 30-day readmissions (p < 0.05). They also had worse overall survival (OS) & disease-free survival (DFS) (p < 0.001), but similar disease-specific survival (DSS) compared to younger group. Age was not associated with hazard of death (HR 1.01, 0.98–1.03). Rather, CCI (HR 1.29, 1.01–1.5), extramural vascular invasion (HR 4.98, 2.84–8.74), and adjuvant therapy (0.37, 0.21–0.64) were significantly associated with the hazard of death; when controlled for stage, tumor distance from anal verge, and neoadjuvant completion.

      Conclusion

      Comorbidities and lower rates of adjuvant therapy, and not chronologic age, are associated with poor OS of elderly patients with LARC treated with neoadjuvant therapy and major surgery.

      Keywords

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