Skip to main content

Advertisement

SpringerLink
Log in

The Eastern Cooperative Oncology Group Performance Status as a prognostic factor of stage I–III colorectal cancer surgery for elderly patients: a multi-institutional retrospective analysis

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purposes

The relationship between the general condition and long-term prognosis in elderly patients with colorectal cancer (CRC) undergoing curative surgery remains unclear. This study investigated the risk factors for poor long-term outcomes in elderly patients with CRC.

Methods

Data of pStage I to III patients with CRC ≥ 80 years old who underwent curative surgery were collected from a multi-institutional database of the Japanese study group for postoperative follow-up of CRC. We retrospectively investigated the poor prognostic factors for the overall survival (OS) and relapse-free survival (RFS).

Results

A total of 473 patients with a median age of 83 years were investigated (315, 121, 34, and 3 with an Eastern Cooperative Oncology Group Performance Status [ECOG-PS] 0, 1, 2, and 3, respectively). Multivariate Cox regression analysis showed that ECOG-PS ≥ 2 and positive lymph node metastasis were independently associated with a poor OS (both p < 0.01). Positive lymph node metastasis (p < 0.01) and tumor depth (T3 or T4) (p = 0.02) were independently associated with a poor RFS. In Stages I and II, but not Stage III patients, the OS was significantly worse in those with ECOG-PS ≥ 2 than in those with ECOG-PS ≤ 1.

Conclusion

Preoperative ECOG-PS was a significant prognostic factor for elderly patients with CRC after curative surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Song P, Tang W. The community-based integrated care system in Japan: Health care and nursing care challenges posed by super-aged society. 2019. Biosci Trends.

  2. Mehraneh D Jafari, Fariba Jafari, Wissam J Halabi, Vinh Q Nguyen, Alessio Pigazzi, Joseph C Carmichael et al. Colorectal Cancer Resections in the Aging US Population: A Trend Toward Decreasing Rates and Improved Outcomes. JAMA Surg. 2014; 149(3):267–74.

  3. Samuelsson KS, Egenvall M, Klarin I, Lokk J, Gunnarsson U, Iwarzon M. The older patient's experience of the healthcare chain and information when undergoing colorectal cancer surgery according to the enhanced recovery after surgery concept. J Clin Nurs. 2018; e1580-e1588.

  4. Ghignone F, Hernandez P, Mahmoud NN, Ugolini G. Functional recovery in senior adults undergoing surgery for colorectal cancer: Assessment tools and strategies to preserve functional status. Eur J Surg Oncol. 2020;46(3):387–93.

    Article  CAS  Google Scholar 

  5. Souwer ETD, Hultink D, Bastiaannet E Hamaker ME, Schphorst A, Pronk A, et al. The Prognostic Value of a Geriatric Risk Score for Older Patients with Colorectal Cancer. Ann Surg Oncol. 2019; 26(1): 71–78.

  6. Ugolini G, Pasini F, Ghignone F, Zattoni D, Reggiani MLB, Parlanti D, et al. How to select elderly colorectal cancer patients for surgery: a pilot study in an Italian academic medical center. Cancer Biol Med. 2015;12(4):302–7.

    PubMed  PubMed Central  Google Scholar 

  7. Sobin LH, Gospodarowicz MK, Wittekind C. TNM Classification of Malignant Tumors, 7th Edition. Hoboken, NJ: Wiley-Blackwell, 2019.

  8. Nakajima K, Inomata M, Akagi T, Etoh T, Sugihara K, Watanabe M, et al. Quality control by photo documentation for evaluation of laparoscopic and open colectomy with D3 resection for stage II/III colorectal cancer: Japan Clinical Oncology Group Study JCOG 0404. Jpn J Clin Oncol. 2014;44(9):799–806.

    Article  Google Scholar 

  9. Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T, et al. The Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol. 2020;25(1):1–42.

    Article  Google Scholar 

  10. Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant. 2013;48(3):452–8.

    Article  CAS  Google Scholar 

  11. Shahrokni A, Alexander K. What will perioperative geriatric assessment for older cancer patients look like in 2025? Advantages and limitations of new technologies in geriatric assessment. Eur J Surg Oncol. 2020;46(3):305–9.

    Article  Google Scholar 

  12. Fagard K, Leonard S, Deschodt M, Devriendt E, Wolthuis A, Prenen H, et al. The impact of frailty on postoperative outcomes in individuals aged 65 and over undergoing elective surgery for colorectal cancer: a systematic review. J Geriatr Oncol. 2016;6:479–91.

    Article  Google Scholar 

  13. Montroni I, Ugolini G, Saur NM, Spinelli A, Rostoft S, Millan M, et al. Personalized management of elderly patients with rectal cancer: Expert recommendations of the European Society of Surgical Oncology, European Society of Coloproctology, International Society of Geriatric Oncology, and American College of Surgeons Commission on Cancer. Eur J Surg Oncol. 2018;44(11):1685–702.

    Article  Google Scholar 

  14. Chow R, Chiu N, Bruera E, Krishnan M, Chiu L, Lam H, et al. Inter-rater reliability in performance status assessment among health care professionals: a systematic review. Ann Palliat Med. 2016;5(2):83–92.

    Article  Google Scholar 

  15. Taylor AE, Olver IN, Sivanthan T, Chi M, Purnell C. Observer error in grading performance status in cancer patients. Support Care in Cancer. 1999;7(5):332–5.

    Article  CAS  Google Scholar 

  16. Kelly CM, Shahrokni A. Moving beyond Karnofsky and ECOG performance status assessments with new technologies. J Oncol. 2016;2016:6186543.

    Article  Google Scholar 

  17. Extermann M, Overcash J, Lyman GH, Parr J, Balducci L. Comorbidity and functional status are independent in older cancer patients. J Clin Oncol. 2005;16(4):1582–7.

    Article  Google Scholar 

  18. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2011;56(3):M146–56.

    Article  Google Scholar 

  19. Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K. A standard procedure for creating a frailty index. BMC Geriatr. 2008;30(8):24.

    Article  Google Scholar 

Download references

Acknowledgements

We appreciate the following members of the JFUP-CRC who provided the data: Ichiro Takemasa (Sapporo Medical University); Kenichi Hakamada (Hirosaki University); Hitoshi Kameyama (Niigata University); Yasukimi Takii (Niigata Cancer Center Hospital); Hideki Ueno (National Defense Medical College); Heita Ozawa (Tochigi Cancer Center); Soichiro Ishihara (the University of Tokyo); Keiichi Takahashi (Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital); Yukihide Kanemitsu (National Cancer Center Hospital); Michio Itabashi (Tokyo Women’s Medical University); Tomomichi Kiyomatsu (National Center for Global Health and Medicine); Takeshi Okabayashi (Keio University); Yojiro Hashiguchi (Teikyo University); Tadahiko Masaki (Kyorin University); Masahiko Watanabe (Kitasato University); Kouichi Hanai (Fujita Health University); Koji Komori (Aichi Cancer Center Hospital); Yoshiharu Sakai (Kyoto University); Masayuki Ohue (Osaka Medical Center for Cancer and Cardiovascular Diseases); Shingo Noura (Osaka Rosai Hospital); Naohiro Tomita (Hyogo College of Medicine); and Yoshito Akagi (Kurume University).

Author information

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007, Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, Japan

    Marie Hanaoka, Hitoshi Hino, Akio Shiomi, Hiroyasu Kagawa, Shoichi Manabe, Yusuke Yamaoka & Shunichiro Kato

  2. Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan

    Marie Hanaoka, Shinichi Yamauchi & Yusuke Kinugasa

  3. Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan

    Kenichi Sugihara

Authors
  1. Marie Hanaoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hitoshi Hino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akio Shiomi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroyasu Kagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shoichi Manabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yusuke Yamaoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shunichiro Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shinichi Yamauchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yusuke Kinugasa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kenichi Sugihara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hitoshi Hino.

Ethics declarations

Conflict of interest

Marie Hanaoka and the other co-authors have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hanaoka, M., Hino, H., Shiomi, A. et al. The Eastern Cooperative Oncology Group Performance Status as a prognostic factor of stage I–III colorectal cancer surgery for elderly patients: a multi-institutional retrospective analysis. Surg Today 52, 1081–1089 (2022). https://doi.org/10.1007/s00595-021-02412-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-021-02412-4

Keywords

Search

Navigation