Aim: The oncologic treatment of elderly patients is going on with a lack of evidence due to their underrepresentation in clinical trials. Many data suggest that certain groups of elderly patients, like their younger counterparts, may benefit from the systemic treatment of their metastatic colorectal tumors (mCRC). Method: We performed retrospective data analysis to investigate the clinical course of care and clinical outcomes of 515 patients who received first-line mFOLFIRI-based chemotherapy for mCRC between 1 January 2013 and 31 December 2018 at the Institute of Oncotherapy of the University of Pécs, focusing on a comparison of patients over and under 70 years of age, defined as the cut-off value. Results: 28.7% of the 515 patients were 70 years old and older (median age 73.5 years). Compared to the data of the elderly patients, the younger group (median age 61.1 years) had a performance status that was significantly better (average ECOG 1.07 vs. 0.83,p< 0.0001), and significantly more patients received molecularly targeted agents (MTA) (21.6% vs. 51.8%,p< 0.0001); nevertheless, mPFS (241 vs. 285 days,p= 0.3960) and mOS (610 vs. 698 days,p= 0.6305) results did not differ significantly. Considering the 1y PFS OR and the 2ys OS OR values (0.94 [95%CI 0.63–1.41] and 0.72 [95%CI 0.47–1.09], respectively), only a non-significant trend was observed in OS favouring the younger population. Additional analysis of our data proved that the survival in patients over 70 years was positively affected by the addition of MTAs to the doublet chemotherapies, and the reasonable modifications/reductions in dose intensity and the addition of local interventions had similar positive effects as observed in the younger patients’ group. Conclusions: Age stratification of mCRC patients is not professionally justified. Patients over 70 years of age with good performance status and controlled co-morbidities benefit from systemic therapy, its modifications and local treatment to the same extent as younger patients. With the increasing incidence of age-related cancers due to the rising average lifespan, prospective randomised clinical trials are needed to determine the real value of systemic therapy in the elderly and the rational, objective methods of patient selection.
目的：由于老年患者在临床试验中代表性不足，其肿瘤治疗缺乏循证依据。大量数据表明，特定老年患者群体与年轻患者类似，可能从转移性结直肠癌（mCRC）的全身治疗中获益。方法：我们进行了一项回顾性数据分析，旨在探究2013年1月1日至2018年12月31日期间在佩奇大学肿瘤治疗研究所接受一线mFOLFIRI方案化疗的515例mCRC患者的临床治疗过程及结局，重点比较以70岁为界定义的老年（≥70岁）与年轻（<70岁）患者群体。结果：515例患者中28.7%年龄≥70岁（中位年龄73.5岁）。与老年患者数据相比，年轻组（中位年龄61.1岁）体能状态显著更优（平均ECOG评分1.07 vs. 0.83，p<0.0001），且接受分子靶向药物（MTA）治疗的患者比例显著更高（21.6% vs. 51.8%，p<0.0001）；然而，两组的中位无进展生存期（mPFS：241天 vs. 285天，p=0.3960）与中位总生存期（mOS：610天 vs. 698天，p=0.6305）均无显著差异。通过分析1年无进展生存期比值比（OR）与2年总生存期比值比（分别为0.94 [95%CI 0.63–1.41]和0.72 [95%CI 0.47–1.09]），仅观察到总生存期存在倾向于年轻人群的非显著性趋势。进一步数据分析证实，在双药化疗基础上联合MTA可显著改善70岁以上患者的生存；剂量强度的合理调整/降低以及联合局部干预措施，在老年患者中产生的积极效应与在年轻患者中观察到的效果相似。结论：对mCRC患者进行年龄分层缺乏专业依据。体能状态良好且合并症控制稳定的70岁以上患者，能够从全身治疗及其调整方案和局部治疗中获得与年轻患者同等程度的获益。随着平均寿命延长导致年龄相关癌症发病率上升，亟需开展前瞻性随机临床试验，以明确全身治疗在老年患者中的实际价值，并建立理性、客观的患者筛选方法。
肿瘤(癌症)患者之家