Geriatric assessment predicts survival and competing mortality in colorectal cancer elderly patients. Can it help in adjuvant therapy decision?

Abstract

Background: The selection of elderly patients with colorectal cancer (CCR) for adjuvant therapy remains a challenge. The main critical issue is to estimate if the patient risk of dying from non-cancer-related (NCR) causes prelude cancer events. The aim of this paper is to evaluate whether an abbreviated Comprehensive Geriatric Assessment (aCGA) could predict survival and cancer mortality in high-risk resected CCR elderly patients candidates to adjuvant therapy. Methods: 195 consecutive patients aged ≥75 with high-risk stage II and III CCR were prospectively enrolled. All patients underwent aCGA, which included comorbidity, polypharmacy, functional status, geriatric syndromes, mood, cognition and social support. According to aCGA results, patients were classified as: “fit” (F), “medium fit” (MF) and “unfit” (UF) to receive standard therapy, adjusted treatment and best support care, respectively. Patients were followed-up for at least 6 months or until death, and toxicity, survival and the cause of death were recorded. A competing risk approach was used to evaluated causes of death by oncogeriatric classification. Results: 85 (44%) patients were classified as F, 56 (29%) as MF and 54 (27%) as UF. The 5-year survival rate was 74%, 52% and 27 % in the F, MF and UF, respectively. At the end of the follow-up, 61 (31%) patients had died (14 F, 16 MF and 31UF). The causes of death were cancer progression (CP), NCR, and unknown reason, in 54%, 46% and 1%, respectively; there were not toxicity-related deaths Overall population was more likely to die of CP rather than of NCR cause. However, stratifying by oncogeriatric categories, at the end of 5 year following surgery, 42% F, 52% MF and 15% UF patients died because of CP, while <3% F or MF and 28% UF patients died because of NCR cause. In Fine and Gray adjusted model, UF patients were at significantly greater risk to die of NCR cause (sHR, 22.29 [CI95% 5.24 to 94.78]) and at significantly lower risk of dying of CP (sHR, 0.30 [CI95% 0.09 to 0.96]) in comparision to F patients. Conclusions: aCGA shown efficacy in predicting survival and competing risk of death in elderly patients with high-risk stage II and III CRC who underwent curative resection. aCGA is useful to shape adjuvant decision-making.