Clinical atlas of rectal cancer highlights the barriers and insufficient interventions underlying the unfavorable outcomes in older patients

Zhuoyang Zhao; Jinxin Lin; Shunlun Chen; Xiaolin Wang; Heng Wang; Gaopo Xu; Jianru Wang; Ruwen Zhou; Zenghong Huang; Yingjie Li; Yu Zhang; Xiaoxia Liu; Puning Wang; Meijin Huang; Yanxin Luo; Huichuan Yu

doi:10.1016/j.heliyon.2023.e15966

Clinical atlas of rectal cancer highlights the barriers and insufficient interventions underlying the unfavorable outcomes in older patients

Heliyon. 2023 May 5;9(5):e15966. doi: 10.1016/j.heliyon.2023.e15966. eCollection 2023 May.

Authors

Zhuoyang Zhao^{1

2

3

4

5}, Jinxin Lin^{6

2

3

4

5}, Shunlun Chen^{1

2

3

4

5}, Xiaolin Wang^{2

3

4

5}, Heng Wang^{2

3

4

5}, Gaopo Xu^{2

3

4

5}, Jianru Wang¹, Ruwen Zhou⁷, Zenghong Huang^{6

2

3

4

5}, Yingjie Li^{2

3

4

5}, Yu Zhang^{2

3

4

5}, Xiaoxia Liu^{2

3

4

5}, Puning Wang⁶, Meijin Huang^{6

2

3

4

5}, Yanxin Luo^{6

2

3

4

5}, Huichuan Yu^{6

2

3

4

5}

Affiliations

¹ Department of Spine Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.
² Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China.
³ Guangdong Institute of Gastroenterology, Guangzhou, Guangdong, 510655, China.
⁴ Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China.
⁵ Key Laboratory of Human Microbiome and Chronic Diseases (Sun Yat-sen University), Ministry of Education, China.
⁶ Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China.
⁷ Department of Biostatistics, the Joseph L. Mailman School of Public Health, Columbia University, New York, 10032, United States.

Abstract

Background: Aging confers an increased risk of developing cancer, and the global burden of cancer is cumulating as human longevity increases. Providing adequate care for old patients with rectal cancer is challenging and complex.

Method: A total of 428 and 44,788 patients diagnosed with non-metastatic rectal cancer from a referral tertiary care center (SYSU cohort) and the Surveillance Epidemiology and End Results database (SEER cohort) were included. Patients were categorized into old (over 65 years) and young (aged 50-65 years) groups. An age-specific clinical atlas of rectal cancer was generated, including the demographic and clinicopathological features, molecular profiles, treatment strategies, and clinical outcomes.

Results: Old and young patients were similar in clinicopathological risk factors and molecular features, including TNM stage, tumor location, tumor differentiation, tumor morphology, lymphovascular invasion, and perineural invasion. However, old patients had significantly worse nutritional status and more comorbidities than young patients. In addition, old age was independently associated with less systemic cancer treatment (adjusted odds ratio 0.294 [95% CI 0.184-0.463, P < 0.001]). We found that old patients had significantly worse overall survival (OS) outcomes in both SYSU (P < 0.001) and SEER (P < 0.001) cohorts. Moreover, the death and recurrence risk of old patients in the subgroup not receiving chemo/radiotherapy (P < 0.001 for OS, and P = 0.046 for time to recurrence [TTR]) reverted into no significant risk in the subgroup receiving chemo/radiotherapy.

Conclusions: Although old patients had similar tumor features to young patients, they had unfavorable survival outcomes associated with insufficient cancer care from old age. Specific trials with comprehensive geriatric assessment for old patients are needed to identify the optimal treatment regimens and improve unmet cancer care.

Study registration: The study was registered on the research registry with the identifier of researchregistry 7635.

Keywords: Aging; Cancer care; Comorbidity; Nutrition; Old patients; Rectal cancer.