Clinical Outcomes of Adjuvant Chemotherapy in Elderly Patients with Resected Stage II and III Colon Cancer: A Real Life Data

Mehmet Zahid Koçak; Murat Araz; Mustafa Karaağaç; Mustafa Korkmaz; Aykut Demirkıran; Engin Hendem; Melek Karakurt Eryılmaz; Mehmet Artaç

doi:10.20515/otd.1657501

Research Article

Opere Evre II ve III Kolon Kanserli Yaşlı Hastalarda Adjuvan Kemoterapinin Klinik Sonuçları: Gerçek Yaşam Verileri

Year 2025, Volume: 47 Issue: 4, 623 - 629, 18.06.2025

Mehmet Zahid Koçak , Murat Araz , Mustafa Karaağaç , Mustafa Korkmaz , Aykut Demirkıran , Engin Hendem , Melek Karakurt Eryılmaz , Mehmet Artaç

Abstract

Bu çalışma, opere evre II ve III kolon kanserli yaşlı hastalarda adjuvan kemoterapinin klinik pratikteki etkinliğini ve tolere edilebilirliğini değerlendirmeyi amaçladı. Hasta popülasyonu adjuvan kemoterapi alan ve almayan grup olarak iki gruba ayrıldı. Gruplar arasında klinik özellikler, genel sağkalım (OS) ve hastalıksız sağkalım (DFS) karşılaştırıldı. OS için bağımsız risk faktörlerini belirlemek için Cox regresyon analizi kullanıldı. Adjuvan kemoterapi alan grup ile almayan arasında, OS için Hazard oranı (HR) 0.80 (%95 Güven aralığı [CI]: 0.66-0.90) (p=0.0025) tespit edildi. Bu grupların DFS'leri arasında istatistiksel olarak anlamlı bir fark yoktu (HR:1.02, %95 GA: 0.75-1,35) (p=0.96). Çok değişkenli analizde (yaş, perforasyon, obstrüksiyon, hastalık evresi, yeterli lenf nodu, tümör tarafı) ve tek değişkenli analizde yaş, OS için bağımsız bir prediktif belirteç değildi. Adjuvan kemoterapi hem evre II hem de evre III kolon kanserli yaşlı hastalarda etkiliydi ve toksisitesi yönetilebilirdi. Adjuvan kemoterapi kararı, kronolojik yaştan ziyade biyolojik yaşına ve hastanın fonksiyonel değerlendirmesine dayanmalıdır

Keywords

kolon kanseri, adjuvan kemoterapi, toksisite, yaşlı hasta

References

1.André T, Boni C, Navarro M et al. Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J Clin Oncol. 2009; 27: 3109-3116.
2. Schmoll H-J, Tabernero J, Maroun J et al. Capecitabine plus oxaliplatin compared with fluorouracil/folinic acid as adjuvant therapy for stage III colon cancer: final results of the NO16968 randomized controlled phase III trial. J Clin Oncol. 2015; 33: 3733-3740.
3. Sanoff HK, Carpenter WR, Stürmer T et al. Effect of adjuvant chemotherapy on survival of patients with stage III colon cancer diagnosed after age 75 years. J Clin Oncol. 2012; 30: 2624.
4. Gill S, Loprinzi CL, Sargent DJ et al. Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much? J Clin Oncol. 2004; 22: 1797-1806.
5. André T, Boni C, Mounedji-Boudiaf L et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Eng J Med. 2004; 350: 2343-2351.
6. Kuebler JP, Wieand HS, O'Connell MJ et al. Oxaliplatin combined with weekly bolus fluorouracil and leucovorin as surgical adjuvant chemotherapy for stage II and III colon cancer: results from NSABP C-07. J Clin Oncol. 2007; 25: 2198-2204.
7. O'Connor ES, Greenblatt DY, LoConte NK et al. Adjuvant chemotherapy for stage II colon cancer with poor prognostic features. J Clin Oncol. 2011; 29: 3381.
8. Hershman D, Hall MJ, Wang X et al. Timing of adjuvant chemotherapy initiation after surgery for stage III colon cancer. Cancer. 2006; 107: 2581-2588.
9. Dobie SA, Warren JL, Matthews B et al. Survival benefits and trends in use of adjuvant therapy among elderly stage II and III rectal cancer patients in the general population. Cancer. 2008; 112: 789-799.
10. John V, Mashru S, Lichtman SM. Pharmacological factors influencing anticancer drug selection in the elderly. Drugs Aging. 2003;20(10):737-759.
11. Golfinopoulos V, Pentheroudakis G, Pavlidis N. Treatment of colorectal cancer in the elderly: a review of the literature. Cancer Treat Rev. 2006;32(1):1-8.
12. Glimelius B, Osterman E. Adjuvant Chemotherapy in Elderly Colorectal Cancer Patients. Cancers. 2020;12(8):2289.
13. Green SL, Dawe DE, Nugent Z et al. The use of chemotherapy in older patients with stage II and III colon cancer: variation by age and era of diagnosis. J Geriatr Oncol. 2019; 10: 132-137.
14. McCleary NJ, Meyerhardt JA, Green E et al. Impact of age on the efficacy of newer adjuvant therapies in patients with stage II/III colon cancer: findings from the ACCENT database. J Clin Oncol. 2013; 31: 2600..
15. Nitsche U, Stöss C, Friess H. Effect of adjuvant chemotherapy on elderly colorectal cancer patients: lack of evidence. Gastrointes Tumor. 2017; 4: 11-19.
16. Manfredi S, Bouvier A, Lepage C et al. Incidence and patterns of recurrence after resection for cure of colonic cancer in a well defined population. Brit J Surg. 2006; 93: 1115-1122.
17. Sargent DJ, Goldberg RM, Jacobson SD et al. A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients. N Eng J Med. 2001; 345: 1091-1097.
18. Van Erning F, Creemers G, de Hingh I et al. Reduced risk of distant recurrence after adjuvant chemotherapy in elderly stage III colon cancer patients. J Geriatr Oncol. 2013; 4: S42.
19. Asimakopoulou N, Papakonstantinou P, Souglakos J et al. A retrospective analysis regarding the parameters, which influence the administration of adjuvant chemotherapy in for elderly patients (> 70 years) with stage II or III colon cancer in the daily clinical practice. J Geriatr Oncol. 2013; 4: S40-S41.
20. .Renfro LA, Grothey A, Kerr D et al. Survival following early-stage colon cancer: an ACCENT-based comparison of patients versus a matched international general population. Ann Oncol. 2015; 26: 950-958.
21. Grothey A, Sobrero AF, Shields AF et al. Duration of adjuvant chemotherapy for stage III colon cancer. N Eng J Med. 2018; 378: 1177-1188.
22. Hung A, Mullins CD. Relative effectiveness and safety of chemotherapy in elderly and nonelderly patients with stage III colon cancer: a systematic review. Oncologist 2013; 18: 54.
23. Cheung WY, Renfro LA, Kerr D et al. Determinants of early mortality among 37,568 patients with colon cancer who participated in 25 clinical trials from the adjuvant colon cancer endpoints database. J Clin Oncol. 2016; 34: 1182.

Clinical Outcomes of Adjuvant Chemotherapy in Elderly Patients with Resected Stage II and III Colon Cancer: A Real Life Data

Year 2025, Volume: 47 Issue: 4, 623 - 629, 18.06.2025

Mehmet Zahid Koçak , Murat Araz , Mustafa Karaağaç , Mustafa Korkmaz , Aykut Demirkıran , Engin Hendem , Melek Karakurt Eryılmaz , Mehmet Artaç

Abstract

This study aimed to evaluate the efficacy and tolerability of adjuvant chemotherapy in clinical practice in the elderly patients with resected stage II and III colon cancer. Fifty-three resected stage II and III colon cancer patients respectively evaluated between August 2010 and September 2019 were included. The study population was divided into two group as received adjuvant chemotherapy and non-received group. Clinical features, overall survival (OS) and disease-free survival (DFS) were compared between groups. Cox regression analysis was used to determine independent risk factors for OS. The hazard ratio (HR) for OS in the group given adjuvant chemotherapy, as compared with non-received group, was 0.80 (95% Confidence interval [CI]: 0.66-0.90) (p=0.0025), corresponding to a 20 percent reduction in the risk of mortality. There was no statistically significant difference between the DFS of these groups (HR:1.02, 95% CI: 0.75-1,35) (p=0.96). In multivariate (age, perforation, obstruction, disease stage, adequate lymph node, tumor side) and univariate analysis, age was not an independent predictive marker for OS. Adjuvant chemotherapy was effective and its toxicity manageable for elderly patients both stage II and stage III colon cancer. Adjuvant chemotherapy decisions should be based on a biological age and functional assessment of the patient than chronological age.

Keywords

colon cancer, adjuvant chemotherapy, toxicity, elderly patient.

References

1.André T, Boni C, Navarro M et al. Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J Clin Oncol. 2009; 27: 3109-3116.
2. Schmoll H-J, Tabernero J, Maroun J et al. Capecitabine plus oxaliplatin compared with fluorouracil/folinic acid as adjuvant therapy for stage III colon cancer: final results of the NO16968 randomized controlled phase III trial. J Clin Oncol. 2015; 33: 3733-3740.
3. Sanoff HK, Carpenter WR, Stürmer T et al. Effect of adjuvant chemotherapy on survival of patients with stage III colon cancer diagnosed after age 75 years. J Clin Oncol. 2012; 30: 2624.
4. Gill S, Loprinzi CL, Sargent DJ et al. Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much? J Clin Oncol. 2004; 22: 1797-1806.
5. André T, Boni C, Mounedji-Boudiaf L et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Eng J Med. 2004; 350: 2343-2351.
6. Kuebler JP, Wieand HS, O'Connell MJ et al. Oxaliplatin combined with weekly bolus fluorouracil and leucovorin as surgical adjuvant chemotherapy for stage II and III colon cancer: results from NSABP C-07. J Clin Oncol. 2007; 25: 2198-2204.
7. O'Connor ES, Greenblatt DY, LoConte NK et al. Adjuvant chemotherapy for stage II colon cancer with poor prognostic features. J Clin Oncol. 2011; 29: 3381.
8. Hershman D, Hall MJ, Wang X et al. Timing of adjuvant chemotherapy initiation after surgery for stage III colon cancer. Cancer. 2006; 107: 2581-2588.
9. Dobie SA, Warren JL, Matthews B et al. Survival benefits and trends in use of adjuvant therapy among elderly stage II and III rectal cancer patients in the general population. Cancer. 2008; 112: 789-799.
10. John V, Mashru S, Lichtman SM. Pharmacological factors influencing anticancer drug selection in the elderly. Drugs Aging. 2003;20(10):737-759.
11. Golfinopoulos V, Pentheroudakis G, Pavlidis N. Treatment of colorectal cancer in the elderly: a review of the literature. Cancer Treat Rev. 2006;32(1):1-8.
12. Glimelius B, Osterman E. Adjuvant Chemotherapy in Elderly Colorectal Cancer Patients. Cancers. 2020;12(8):2289.
13. Green SL, Dawe DE, Nugent Z et al. The use of chemotherapy in older patients with stage II and III colon cancer: variation by age and era of diagnosis. J Geriatr Oncol. 2019; 10: 132-137.
14. McCleary NJ, Meyerhardt JA, Green E et al. Impact of age on the efficacy of newer adjuvant therapies in patients with stage II/III colon cancer: findings from the ACCENT database. J Clin Oncol. 2013; 31: 2600..
15. Nitsche U, Stöss C, Friess H. Effect of adjuvant chemotherapy on elderly colorectal cancer patients: lack of evidence. Gastrointes Tumor. 2017; 4: 11-19.
16. Manfredi S, Bouvier A, Lepage C et al. Incidence and patterns of recurrence after resection for cure of colonic cancer in a well defined population. Brit J Surg. 2006; 93: 1115-1122.
17. Sargent DJ, Goldberg RM, Jacobson SD et al. A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients. N Eng J Med. 2001; 345: 1091-1097.
18. Van Erning F, Creemers G, de Hingh I et al. Reduced risk of distant recurrence after adjuvant chemotherapy in elderly stage III colon cancer patients. J Geriatr Oncol. 2013; 4: S42.
19. Asimakopoulou N, Papakonstantinou P, Souglakos J et al. A retrospective analysis regarding the parameters, which influence the administration of adjuvant chemotherapy in for elderly patients (> 70 years) with stage II or III colon cancer in the daily clinical practice. J Geriatr Oncol. 2013; 4: S40-S41.
20. .Renfro LA, Grothey A, Kerr D et al. Survival following early-stage colon cancer: an ACCENT-based comparison of patients versus a matched international general population. Ann Oncol. 2015; 26: 950-958.
21. Grothey A, Sobrero AF, Shields AF et al. Duration of adjuvant chemotherapy for stage III colon cancer. N Eng J Med. 2018; 378: 1177-1188.
22. Hung A, Mullins CD. Relative effectiveness and safety of chemotherapy in elderly and nonelderly patients with stage III colon cancer: a systematic review. Oncologist 2013; 18: 54.
23. Cheung WY, Renfro LA, Kerr D et al. Determinants of early mortality among 37,568 patients with colon cancer who participated in 25 clinical trials from the adjuvant colon cancer endpoints database. J Clin Oncol. 2016; 34: 1182.

There are 23 citations in total.

Details

Primary Language	English
Subjects	Clinical Oncology
Journal Section	ORİJİNAL MAKALE
Authors	Mehmet Zahid Koçak 0000-0003-3085-7964 Murat Araz 0000-0002-4632-9501 Mustafa Karaağaç 0000-0003-4533-0620 Mustafa Korkmaz 0000-0003-0926-6748 Aykut Demirkıran 0000-0002-2842-4695 Engin Hendem 0000-0001-6970-4733 Melek Karakurt Eryılmaz 0000-0003-2597-5931 Mehmet Artaç 0000-0003-2335-3354
Publication Date	June 18, 2025
Submission Date	March 13, 2025
Acceptance Date	May 26, 2025
Published in Issue	Year 2025 Volume: 47 Issue: 4

Cite

Vancouver	Koçak MZ, Araz M, Karaağaç M, Korkmaz M, Demirkıran A, Hendem E, Karakurt Eryılmaz M, Artaç M. Clinical Outcomes of Adjuvant Chemotherapy in Elderly Patients with Resected Stage II and III Colon Cancer: A Real Life Data. Osmangazi Tıp Dergisi. 2025;47(4):623-9.

Article Files

Full Text