Survival benefit from evidence-based treatment for rectal cancer among older people – Analysis of SEER-medicare

IF 2.9 3区医学 Q3 GERIATRICS & GERONTOLOGY

Journal of geriatric oncology Pub Date : 2026-03-01 Epub Date: 2026-01-19 DOI:10.1016/j.jgo.2026.102851

Uma R. Phatak , Yong Shan , Yong-Fang Kuo

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引用次数: 0

Abstract

Introduction

The treatment of stage III rectal cancer (RC) is complex and requires a multidisciplinary approach. Evidence-based guidelines (EBG) exist for the treatment of RC. We aimed to determine adherence to EBG in the treatment of stage III RC and the impact on survival in older adults.

Materials and methods

This is a retrospective study of patients within the Surveillance, Epidemiology, and End Results program (SEER). We included adults with stage III RC between 2007 and 2018 with one pathologically confirmed primary tumor. We defined guideline-based care as receipt of: chemoradiation within 6 months of date of diagnosis; surgery within 6 months of completion of chemoradiation; and chemotherapy after surgery. Overall survival (OS) and cancer-specific survival (CSS) were analyzed using the Kaplan-Meier method. Multivariable Cox regression was performed to determine factors associated with survival.

Results

We identified 3962 patients, and 1945 (49.1%) were female. There were 1707 (43.1%) with a Charlson Comorbidity Index of zero. Of the total, 994 (25.1%) received all guideline-based treatments. Factors associated with lack of guideline-based care included age, comorbidities, income, and geographic location. Guideline-based care was associated with increased OS (HR: 0.55, 95% CI: 0.49–0.60) and CSS (HR: 0.59, 95% CI: 0.48–0.73).

Discussion

Although 43.1% of the cohort had a comorbidity index of zero, only 25.1% received all guideline-based treatments. Deviation from guideline-based care had a significant impact on OS. Our data show that more efforts can be made to recommend multimodal RC treatment among older adults.

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老年人直肠癌循证治疗的生存获益——seer医疗保险分析。

III期直肠癌（RC）的治疗是复杂的，需要多学科的方法。针对RC的治疗存在循证指南（EBG）。我们的目的是确定EBG治疗III期RC的依从性及其对老年人生存的影响。材料和方法：这是一项对监测、流行病学和最终结果项目（SEER）患者的回顾性研究。我们纳入了2007年至2018年间患有III期RC的成年人，其中有一个病理证实的原发肿瘤。我们将基于指南的治疗定义为：诊断后6个月内接受放化疗；放化疗完成后6个月内手术；还有手术后的化疗。采用Kaplan-Meier法分析总生存期（OS）和肿瘤特异性生存期（CSS）。采用多变量Cox回归确定与生存率相关的因素。结果：3962例患者中女性1945例（49.1%）。Charlson合并症指数为零的1707例（43.1%）。其中，994例（25.1%）接受了所有基于指南的治疗。与缺乏基于指南的护理相关的因素包括年龄、合并症、收入和地理位置。基于指南的护理与OS （HR: 0.55, 95% CI: 0.49-0.60）和CSS （HR: 0.59, 95% CI: 0.48-0.73）的增加相关。讨论：尽管43.1%的队列患者的合并症指数为零，但只有25.1%的患者接受了所有基于指南的治疗。偏离基于指南的护理对OS有显著影响。我们的数据表明，在老年人中推荐多模式RC治疗可以做更多的努力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of geriatric oncology ONCOLOGY-GERIATRICS & GERONTOLOGY

CiteScore

5.30

自引率

10.00%

发文量

379

审稿时长

80 days

期刊介绍： The Journal of Geriatric Oncology is an international, multidisciplinary journal which is focused on advancing research in the treatment and survivorship issues of older adults with cancer, as well as literature relevant to education and policy development in geriatric oncology. The journal welcomes the submission of manuscripts in the following categories: • Original research articles • Review articles • Clinical trials • Education and training articles • Short communications • Perspectives • Meeting reports • Letters to the Editor.