Resectability, Resections, Survival Outcomes, and Quality of Life in Older Adult Patients with Metastatic Colorectal Cancer (the RAXO-Study)
: Lehtomäki Kaisa, Soveri Leena-Maija, Osterlund Emerik, Lamminmäki Annamarja, Uutela Aki, Heervä Eetu, Halonen Päivi, Stedt Hanna, Aho Sonja, Muhonen Timo, Ålgars Annika, Salminen Tapio, Kallio Raija, Nordin Arno, Aroviita Laura, Nyandoto Paul, Kononen Juha, Glimelius Bengt, Ristamäki Raija, Isoniemi Helena, Osterlund Pia
Publisher: MDPI
: 2023
Journal of Clinical Medicine
: JOURNAL OF CLINICAL MEDICINE
: J CLIN MED
: 3541
: 12
: 10
: 21
: 2077-0383
DOI: https://doi.org/10.3390/jcm12103541
: https://doi.org/10.3390/jcm12103541
: https://research.utu.fi/converis/portal/detail/Publication/179872099
Older adults are underrepresented in metastatic colorectal cancer (mCRC) studies and thus may not receive optimal treatment, especially not metastasectomies. The prospective Finnish real-life RAXO-study included 1086 any organ mCRC patients. We assessed repeated centralized resectability, overall survival (OS), and quality of life (QoL) using 15D and EORTC QLQ-C30/CR29. Older adults (>75 years; n = 181, 17%) had worse ECOG performance status than adults (<75 years, n = 905, 83%), and their metastases were less likely upfront resectable. The local hospitals underestimated resectability in 48% of older adults and in 34% of adults compared with the centralized multidisciplinary team (MDT) evaluation (p < 0.001). The older adults compared with adults were less likely to undergo curative-intent R0/1-resection (19% vs. 32%), but when resection was achieved, OS was not significantly different (HR 1.54 [CI 95% 0.9-2.6]; 5-year OS-rate 58% vs. 67%). 'Systemic therapy only' patients had no age-related survival differences. QoL was similar in older adults and adults during curative treatment phase (15D 0.882-0.959/0.872-0.907 [scale 0-1]; GHS 62-94/68-79 [scale 0-100], respectively). Complete curative-intent resection of mCRC leads to excellent survival and QoL even in older adults. Older adults with mCRC should be actively evaluated by a specialized MDT and offered surgical or local ablative treatment whenever possible.
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